Crit Care Med

Expert group releases new guidelines for heat stroke management

April 8, 2025

The Society of Critical Care Medicine assembled a multidisciplinary panel of 18 international experts, a patient representative, and a guidelines methodologist, ensuring adherence to conflict-of-interest policies throughout the development of evidence-based recommendations for the management of heat stroke.

Key recommendations

Cooling modalities

• Active cooling methods (strong recommendation, very low certainty): Use active cooling (e.g., cold-water immersion) over passive methods for heat stroke. Active cooling reduces temperature faster, which is crucial for patient outcomes.
• Rapid cooling priority (good practice statement): Prioritize ice-water or cold-water immersion for the fastest cooling rates. These methods are most effective in reducing core body temperature quickly.
• Similar strategies for heat stroke types (good practice statement): Clinicians may apply similar cooling strategies for both classic and exertional heat stroke due to the harmful effects of extreme body temperatures.
• Target temperature within 30 minutes (good practice statement): Aim to reach a core temperature of <39°C within 30 minutes of recognizing heat stroke symptoms to improve survival rates.
• Cooling rate ≥0.155°C/min (good practice statement): Use cooling methods that achieve a rate of ≥0.155°C/min to ensure rapid temperature reduction and better outcomes.

Medications that affect temperature control

• Recommend against dantrolene use (strong recommendation, very low certainty): Don't use dantrolene for heat stroke as it shows no significant benefit in reducing mortality or cooling time.
• Avoid antipyretics (good practice statement): Avoid acetaminophen, NSAIDs, and salicylates for temperature reduction in heat stroke due to lack of benefit and potential adverse effects.

Research context

• Prophylactic antibiotics and antiseizure meds (only-in-the-context of research statement): Use prophylactic antibiotics or antiseizure medications only in research settings until more evidence is available.

Source:

Barletta JF, et al. (2025, February 21). Crit Care Med. Society of Critical Care Medicine Guidelines for the Treatment of Heat Stroke. https://pubmed.ncbi.nlm.nih.gov/39982186/