Heat stroke

Toru Hifumi,Yasufumi Miyake,Keiki Shimizu,Yutaka Kondo

doi:10.1186/s40560-018-0298-4

Abstract

BackgroundHeat stroke is a life-threatening injury requiring neurocritical care; however, heat stroke has not been completely examined due to several possible reasons, such as no universally accepted definition or classification, and the occurrence of heat wave victims every few years. Thus, in this review, we elucidate the definition/classification, pathophysiology, and prognostic factors related to heat stroke and also summarize the results of current studies regarding the management of heat stroke, including the use of intravascular balloon catheter system, blood purification therapy, continuous electroencephalogram monitoring, and anticoagulation therapy.Main bodyTwo systems for the definition/classification of heat stroke are available, namely Bouchama’s definition and the Japanese Association for Acute Medicine criteria. According to the detailed analysis of risk factors, prevention strategies for heat stroke, such as air conditioner use, are important. Moreover, hematological, cardiovascular, neurological, and renal dysfunctions on admission are associated with high mortality, which thus represent the potential targets for intensive and specific therapies for patients with heat stroke. No prospective, comparable study has confirmed the efficacy of intravascular cooling devices, anticoagulation, or blood purification in heat stroke.ConclusionThe effectiveness of cooling devices, drugs, and therapies in heat stroke remains inconclusive. Further large studies are required to continue to evaluate these treatment strategies.

Highlights

Heat stroke is a life-threatening injury requiring neurocritical care; heat stroke has not been completely examined due to several possible reasons, such as no universally accepted definition or classification, and the occurrence of heat wave victims every few years
In the current review, we elucidate the definition/classification, pathophysiology, and prognostic factors associated with heat stroke and summarize the results of current studies regarding the management of heat stroke, including the use of intravascular balloon catheter systems, blood purification therapy, continuous electroencephalogram (cEEG) monitoring, and anticoagulants
Multivariate cox proportional hazard model analysis revealed an independent contribution to 2-year mortality if patients were staying at an institution (hazard ratio (HR), 1.98; 95% confidence interval (CI), 1.05–3.71), if they used long-term antihypertensive medications (HR, 2.17; 95% CI, 1.17–4.05), or if they presented with anuria (HR, 5.24; 95% CI, 2.29–12.03), coma (HR, 2.95; 95% CI, 1.26–6.91), or cardiovascular failure (HR, 2.43; 95%CI, 1.14–5.17) at admission [2]