Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion

Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison...

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Autores principales:	Jun Kanda, Shinji Nakahara, Shunsuke Nakamura, Yasufumi Miyake, Keiki Shimizu, Shoji Yokobori, Arino Yaguchi, Tetsuya Sakamoto
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/ee6b1d6160c84b5ba78ea45b750b9531
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spelling	oai:doaj.org-article:ee6b1d6160c84b5ba78ea45b750b95312021-11-25T06:19:46ZAssociation between active cooling and lower mortality among patients with heat stroke and heat exhaustion1932-6203https://doaj.org/article/ee6b1d6160c84b5ba78ea45b750b95312021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8598059/?tool=EBIhttps://doaj.org/toc/1932-6203Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the “severe” group or the “mild-to-moderate” group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received “active cooling + rehydration” and patients who received “rehydration only,” with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.Jun KandaShinji NakaharaShunsuke NakamuraYasufumi MiyakeKeiki ShimizuShoji YokoboriArino YaguchiTetsuya SakamotoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jun Kanda Shinji Nakahara Shunsuke Nakamura Yasufumi Miyake Keiki Shimizu Shoji Yokobori Arino Yaguchi Tetsuya Sakamoto Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
description	Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the “severe” group or the “mild-to-moderate” group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received “active cooling + rehydration” and patients who received “rehydration only,” with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.
format	article
author	Jun Kanda Shinji Nakahara Shunsuke Nakamura Yasufumi Miyake Keiki Shimizu Shoji Yokobori Arino Yaguchi Tetsuya Sakamoto
author_facet	Jun Kanda Shinji Nakahara Shunsuke Nakamura Yasufumi Miyake Keiki Shimizu Shoji Yokobori Arino Yaguchi Tetsuya Sakamoto
author_sort	Jun Kanda
title	Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_short	Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_full	Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_fullStr	Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_full_unstemmed	Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
title_sort	association between active cooling and lower mortality among patients with heat stroke and heat exhaustion
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/ee6b1d6160c84b5ba78ea45b750b9531
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Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion

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