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Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review

Background and Objectives: The purpose of this systematic review is to synthesize the influence cooling modality has on survival with and without medical complications from exertional heat stroke (EHS) in sport and military populations. Methods and Materials: All peer-reviewed case reports or series...

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Autores principales: Filep, Erica M., Murata, Yuki, Endres, Brad D., Kim, Gyujin, Stearns, Rebecca L., Casa, Douglas J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694459/
https://www.ncbi.nlm.nih.gov/pubmed/33167534
http://dx.doi.org/10.3390/medicina56110589
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author Filep, Erica M.
Murata, Yuki
Endres, Brad D.
Kim, Gyujin
Stearns, Rebecca L.
Casa, Douglas J.
author_facet Filep, Erica M.
Murata, Yuki
Endres, Brad D.
Kim, Gyujin
Stearns, Rebecca L.
Casa, Douglas J.
author_sort Filep, Erica M.
collection PubMed
description Background and Objectives: The purpose of this systematic review is to synthesize the influence cooling modality has on survival with and without medical complications from exertional heat stroke (EHS) in sport and military populations. Methods and Materials: All peer-reviewed case reports or series involving EHS patients were searched in the following online databases: PubMed, Scopus, SPORTDiscus, Medline, CINAHL, Academic Search Premier, and the Cochrane Library: Central Registry of Clinical Trials. Cooling methods were subdivided into “adequate” (>0.15 °C/min) versus “insufficient” (<0.15 °C/min) based on previously published literature on EHS cooling rates. Results: 613 articles were assessed for quality and inclusion in the review. Thirty-two case reports representing 521 EHS patients met the inclusion criteria. Four hundred ninety-eight (498) patients survived EHS (95.58%) and 23 (4.41%) patients succumbed to complications. Fischer’s Exact test on 2 × 2 contingency tables and relative risk ratios were calculated to determine if modality cooling rate was associated with patient outcomes. EHS patients that survived who were cooled with an insufficient cooling rate had a 4.57 times risk of medical complications compared to patients who were treated by adequate cooling methods, regardless of setting (RR = 4.57 (95%CI: 3.42, 6.28)). Conclusions: This is the largest EHS dataset yet compiled that analyzes the influence of cooling rate on patient outcomes. Zero patients died (0/521, 0.00%) when treatment included a modality with an adequate cooling rate. Conversely, 23 patients died (23/521, 4.41%) with insufficient cooling. One hundred seventeen patients (117/521, 22.46%) survived with medical complications when treatment involved an insufficient cooling rate, whereas, only four patients had complications (4/521, 0.77%) despite adequate cooling. Cooling rates >0.15 °C/min for EHS patients were significantly associated with surviving EHS without medical complications. In order to provide the best standard of care for EHS patients, an aggressive cooling rate >0.15 °C/min can maximize survival without medical complications after exercise-induced hyperthermia.
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spelling pubmed-76944592020-11-28 Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review Filep, Erica M. Murata, Yuki Endres, Brad D. Kim, Gyujin Stearns, Rebecca L. Casa, Douglas J. Medicina (Kaunas) Review Background and Objectives: The purpose of this systematic review is to synthesize the influence cooling modality has on survival with and without medical complications from exertional heat stroke (EHS) in sport and military populations. Methods and Materials: All peer-reviewed case reports or series involving EHS patients were searched in the following online databases: PubMed, Scopus, SPORTDiscus, Medline, CINAHL, Academic Search Premier, and the Cochrane Library: Central Registry of Clinical Trials. Cooling methods were subdivided into “adequate” (>0.15 °C/min) versus “insufficient” (<0.15 °C/min) based on previously published literature on EHS cooling rates. Results: 613 articles were assessed for quality and inclusion in the review. Thirty-two case reports representing 521 EHS patients met the inclusion criteria. Four hundred ninety-eight (498) patients survived EHS (95.58%) and 23 (4.41%) patients succumbed to complications. Fischer’s Exact test on 2 × 2 contingency tables and relative risk ratios were calculated to determine if modality cooling rate was associated with patient outcomes. EHS patients that survived who were cooled with an insufficient cooling rate had a 4.57 times risk of medical complications compared to patients who were treated by adequate cooling methods, regardless of setting (RR = 4.57 (95%CI: 3.42, 6.28)). Conclusions: This is the largest EHS dataset yet compiled that analyzes the influence of cooling rate on patient outcomes. Zero patients died (0/521, 0.00%) when treatment included a modality with an adequate cooling rate. Conversely, 23 patients died (23/521, 4.41%) with insufficient cooling. One hundred seventeen patients (117/521, 22.46%) survived with medical complications when treatment involved an insufficient cooling rate, whereas, only four patients had complications (4/521, 0.77%) despite adequate cooling. Cooling rates >0.15 °C/min for EHS patients were significantly associated with surviving EHS without medical complications. In order to provide the best standard of care for EHS patients, an aggressive cooling rate >0.15 °C/min can maximize survival without medical complications after exercise-induced hyperthermia. MDPI 2020-11-05 /pmc/articles/PMC7694459/ /pubmed/33167534 http://dx.doi.org/10.3390/medicina56110589 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Filep, Erica M.
Murata, Yuki
Endres, Brad D.
Kim, Gyujin
Stearns, Rebecca L.
Casa, Douglas J.
Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review
title Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review
title_full Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review
title_fullStr Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review
title_full_unstemmed Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review
title_short Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review
title_sort exertional heat stroke, modality cooling rate, and survival outcomes: a systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694459/
https://www.ncbi.nlm.nih.gov/pubmed/33167534
http://dx.doi.org/10.3390/medicina56110589
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