Cold-Water Dousing with Ice Massage to Treat Exertional Heat Stroke: A Case Series

McDERMOTT BP, CASA DJ, O'CONNOR FG, ADAMS WB, ARMSTRONG LE, BRENNAN AH, LOPEZ RM, STEARNS RL, TROYANOS C, YEARGIN SW. Cold-water dousing with ice massage to treat exertional heat stroke: a case series. Aviat Space Environ Med 2009; 80:720-2. Introduction: We sought to determine the rate of cooling via a novel water ice therapy (WIT) as an alternative to cold-water immersion for the acute treatment of exertional heat stroke (EHS). Methods: Observations were made at the 2004-2008 Marine Corps Marathons (mean SD +/- 16.3 +/- 4.9 degrees C dry bulb, 32 +/- 6% RH). Nine (seven men, two women) EHS patients (33 +/- 6 yr of age; 268 +/- 54 min average race time for six who finished) were observed during on-site treatment. Patients were treated while lying supine on a porous stretcher resting on a tub filled with cold water (similar to 10-12 degrees C). Medical personnel monitored T-re, doused the patient with water and massaged major muscle groups with ice bags until T-re decreased to 38.9 degrees C. Patients were not immersed in water. Serial T,, and time were used to calculate cooling rates. Results: Final T-re (39.12 +/- 0.63 degrees C) was significantly lower than initial T-re (41.43 +/- 0.71 degrees C, P < 0.05). Cooling rates were 0.13 +/- 0.04 degrees C . min(-1). The decrease in T-re for the initial 6 min of WIT (0.38 +/- 0.13 degrees C) was significantly less than for the subsequent 6-min time period (1.31 +/- 0.34 degrees C, P < 0.001). Cooling rates for these time periods were significantly different (0.06 +/- 0.02 degrees C . min(-1) and 0.22 +/- 0.06 degrees C . min(-1), respectively, P < 0.05). Initial T-re was not correlated with overall cooling rate (r = 0.434, P = 0.244), or total cooling time required (17 +/- 4 min; r = 0.207, P = 0.593). Survival rate was 100%. Conclusion: WIT provided cooling rates that were 70% as effective as those published for cold-water immersion with 8 degrees C water (0.19 degrees C . min(-1)) and resulted in 100% patient survival.