title: Should Cooling Vests Be Used to Treat Exertional Heatstroke? A Critically Appraised Topic.
abstract: Clinical Scenario: Exercise performed in hot and humid environments increases core body temperature (TC). If TCexceeds 40.5°C for prolonged periods of time, exertional heat stroke (EHS) may occur. EHS is a leading cause of sudden death in athletes. Mortality and morbidity increase the longer the patient's TCremains above 40.5°C; thus, it is imperative to initiate cooling as quickly as possible. Acceptable cooling rates in EHS situations are 0.08-0.15°C/min, while ideal cooling rates are above 0.16°C/min. Cooling vests are popular alternatives for cooling hyperthermic adults. Most vests cover the anterior and posterior torso and have varying numbers of pouches for phase-change materials (eg, gel packs); some vests only use circulating water to cool. While cooling vests offer several advantages (eg, portability), studies demonstrating their effectiveness at rapidly reducing TCin EHS scenarios are limited.
  
  
  OBJECTIVE
  Are TCcooling rates acceptable (ie, >0.08°C/min) when hyperthermic humans are treated with cooling vests postexercise?
  
  
  RESULTS
  No significant differences in TCcooling rates occurred between cooling vests and no cooling vests. Cooling rates across all studies were ≤0.053°C/min. Clinical Bottom Line: Cooling vests do not provide acceptable cooling rates of hyperthermic humans postexercise and should not be used to treat EHS. Instead, EHS patients should be treated with cold-water immersion within 30 min of collapse to avoid central nervous system dysfunction and organ failure. Strength of Recommendation: Strong evidence (eg, level 2 studies with PEDro scores ≥5) suggests that cooling vests do not reduce TCquickly and thus should not be used in EHS scenarios.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Keen
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Miller
mesh_terms: D001831:Body Temperature; D003020:Clothing; D018883:Heat Stroke / Q000628:therapy*; D006801:Humans; D007101:Immersion; D016032:Randomized Controlled Trials as Topic; D014867:Water
chemical_list: D014867:Water
keywords: heat stroke; hyperthermia; treatment