Outcomes of UK military personnel treated with ice cold water immersion for exertional heat stroke
Wood F, Roiz-de-Sa D, Pynn H, Smith JE, Bishop J, Hemingway R
BMJ military health · 9 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2022-10-06 · BMJ Mil Health · vol. 170 · issue 3 · pp. 216–222
- Publisher
- BMJ
- Cited
- 11 citations · more than 75% of similar papers · 1.0× the field average
- References
- 20 works
- Access
- Paywalled
- Research areas
- Thermoregulation and physiological responses · Exercise and Physiological Responses · Thermal Regulation in Medicine
- Keywords
- Medicine, Heat illness, Cohort, Emergency medicine, Cohort study, Adverse effect, Stroke (engine), Incidence (geometry), Body mass index, Physical therapy, Internal medicine
- MeSH
- humans, heat stroke, prospective studies, immersion, adult, military personnel, female, male, cold temperature, united kingdom
6 authors
From GB
- Felix Wood · correspondingRoyal Navy; Derriford Hospital; Royal Centre for Defence Medicine
- D Roiz-de-SaUniversity of Portsmouth
- Harvey J PynnCambridge Military Hospital; Bristol Royal Infirmary
- Jason Edward SmithRoyal Navy; Derriford Hospital; Royal Centre for Defence Medicine
- Jonathan R. B. BishopNIHR Surgical Reconstruction and Microbiology Research Centre; University of Birmingham
- R HemingwayRoyal Navy
Abstract
Introduction
Despite mitigation efforts, exertional heat stroke (EHS) is known to occur in military personnel during training and operations. It has significant potential to cause preventable morbidity and mortality. International consensus from sports medicine organisations supports treating EHS with early rapid cooling by immersing the casualty in cold water. However, evidence remains sparse and the practice is not yet widespread in the UK.
Methods
Following changes to enable on-site ice cold water immersion (ICWI) at the Royal Marines Commando Training Centre, Lympstone, UK, we prospectively gathered data on 35 patients treated with ICWI over a 3-year period. These data included the incidence of adverse events (e.g. death, cardiac arrest or critical care admission) as the primary outcome. Basic anthropometric data, cooling rates achieved and biochemical and haematological test results on days 0-5 were also gathered and analysed.
Results
Despite being a cohort of patients in whom we might expect significant morbidity and mortality based on the severity of EHS at presentation, none experienced a serious adverse event. In this cohort with rapid initiation of effective cooling, biochemical derangement appeared less severe than that reported in previous studies. Higher body mass index (BMI) was associated with a lower cooling rate across a range of values previously reported as potentially of clinical significance.
Conclusions
This case series supports recent updates to UK military guidance that ICWI should be more widely adopted for the treatment of EHS. Clinicians should be aware of likely patterns of blood test abnormalities in the days following EHS. Further work should seek to establish the impact of lower rates of cooling and develop strategies to optimise cooling in patients with higher BMI.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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