Cold Water Immersion: The Gold Standard for Exertional Heatstroke Treatment

  title={Cold Water Immersion: The Gold Standard for Exertional Heatstroke Treatment},
  author={Douglas J. Casa and Brendon P. McDermott and Elaine Choung-Hee Lee and Susan W Yeargin and Lawrence E. Armstrong and Carl M. Maresh},
  journal={Exercise and Sport Sciences Reviews},
The key to maximize the chances of surviving exertional heatstroke is rapidly decreasing the elevated core body temperature. Many methods exist to cool the body, but current evidence strongly supports the use of cold water. Preferably, the athlete should be immersed in cold water. If lack of equipment or staff prevents immersion, a continual dousing with cold water provides an effective cooling modality. We refute the many criticisms of this treatment and provide scientific evidence supporting… 
Hypothermia following cold-water immersion treatment for exertional heat illness.
The importance of proper CWI execution in order to avoid harm is illustrated in this case series, where three runners presented to the emergency department with symptomatic mild hypothermia requiring re-warming following a major marathon.
Heat and Hydration Curriculum Issues: Part 4 of 4—Cold Water Immersion
Addressing the proper treatment for EHS is an essential aspect of an Athletic Training Education Program (ATEP), because the NATA Educational Competencies requires athletic training students to be taught management skills for environmental illnesses.
Treatment of hyperthermia: is assessment of cooling efficiency enough?
While cooling efficiency over a 40 min period after exercise-induced hyperthermia was similar amongst cold intravenous infusion, ice pack and fan misting conditions, parasympathetic reactivation, as evidenced by heart rate (HR) variability (HRV) analysis, was clearly different.
An Alternative Method for Treating Exertional Heat Stroke: Tarp-Assisted Cooling
  • W. Adams
  • Medicine
    Athletic Training & Sports Health Care
  • 2019
The aim of this commentary is to provide clinicians with an alternative option for the treatment of exertional heat stroke in the event of cold water immersion not being available or feasible at a location where exertionalHeat stroke occurs.
Cold-water immersion and the treatment of hyperthermia: using 38.6°C as a safe rectal temperature cooling limit.
Immersion for approximately 9 minutes to a rectal temperature cooling limit of 38.6°C negated any risk associated with overcooling hyperthermic individuals when they were immersed in 2°C water.
Heat-Stress Exercise and Cooling
  • C. Tyler
  • Education
    Heat Stress in Sport and Exercise
  • 2019
Athletes regularly adopt cooling strategies before (pre-cooling) and/or during (per-cooling) exercise in the heat to alleviate the extra thermal strain. The most effective cooling interventions
Effectiveness of cold water immersion for treating exertional heat stress when immediate response is not possible
The results support that CWI is the most appropriate treatment for exertional heatstroke as it is capable of quickly reversing hyperthermia even when treatment is commenced with a significant delay.
Water immersion in the treatment of exertional hyperthermia: physical determinants.
It is shown that individuals with a low AD/LBM have a reduced rectal cooling rate and take longer to cool than those with a high AD/ LBM during both CWI and TWI, however, CWI provides the most effective cooling treatment irrespective of physical differences.
Exertional Heat Illnesses
Exercising in hot, humid environments can have a negative impact on exercise performance and one’s health. Strategies such as gradually becoming accustomed to exercise in new environments, adequate
Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia.
Although the CS facilitated cooling rates faster than no treatment, clinicians should continue to advocate for accepted cooling modalities and use CS only if no other validated means of cooling are available.


Emergency treatment of exertional heatstroke and comparison of whole body cooling techniques.
  • A. Costrini
  • Medicine
    Medicine and science in sports and exercise
  • 1990
This manuscript compares the whole body cooling techniques in the emergency treatment of heatstroke and concludes that ice water immersion with skin massage is the most effective method.
Cooling heat stroke patients by available field measures
The most acceptable cooling techniques include ice water immersion, exploiting the high conductive properties of water and methods based on evaporation achieved by using powerful fans on wet skin.
Ice-Water Immersion and Cold-Water Immersion Provide Similar Cooling Rates in Runners With Exercise-Induced Hyperthermia.
Cooling rates were nearly identical between ice-water immersion and cold- water immersion, while both were 38% more effective in cooling after 12 minutes of immersion than the mock-immersion trial.
Whole-body cooling of hyperthermic runners: comparison of two field therapies.
Exertional heat stroke in competitive athletes
Critical misconceptions that pertain to the prevention, recognition, and treatment of EHS are focused on, including the randomness of EHR cases, the role of nutritional supplements in EHS, temperature assessment, onset of E HS and the possible lucid interval, and return to play.
Body cooling as a method for reducing hyperthermia. An evaluation of techniques.
It was found that strategically placing instant cold packs (ICPs) (Coldpak; Medac) over the large vessels of the neck, axillae and groin was not significantly more effective than passive body cooling in bringing about a 2 degrees C reduction in rectal temperature.
Exertional heat illness during training and competition
Prevention strategies are essential to reducing the incidence of EHS, heat exhaustion, and exercise associated muscle cramping.
Heat stroke.
A heat stroke is when the body becomes unable to control its temperature: the body's temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down.
Methods of cooling subjects with hyperpyrexia.
‘Afterdrop’ in rectal temperature after ice-cold water cooling may be associated with severe circulatory shock and oral temperatures are a less reliable index of core temperature than rectal.
American College of Sports Medicine position stand. Exertional heat illness during training and competition.
Prevention strategies are essential to reducing the incidence of EHS, heat exhaustion, and exercise associated muscle cramping as well as the morbidity and mortality associated with EHS.