How is ice water immersion cooling performed in the treatment of hyperthermia?

Updated: Oct 14, 2020
  • Author: Erik D Schraga, MD; Chief Editor: Sage W Wiener, MD  more...
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This is the fastest and most efficient noninvasive technique for cooling, and it should be the first-line treatment for patients with severe hyperthermia of any etiology. This technique involves immersing the patient in an ice-water bath, which results in reduction of core temperature approximately 0.15-0.35°C per minute. [12, 13, 14, 15]

The vasoconstriction induced by ice water can be beneficial to patients experiencing hypotension. This technique is safe when used for patients with exertional heatstroke (eg, athletes, military recruits), but caution should be used in patients with classic heatstroke (eg, elderly patients, patients with alcoholism), who have been reported to have a mortality rate of up to 14% associated with this cooling method. However, even in these patients, the benefits of rapid cooling usually outweigh the risks of the procedure.

Remove all of the patient’s clothing.

Position the patient in tub of water (0-15°C) so that the patient’s chest and extremities are completely immersed with the head supported outside of the tub. If a tub is unavailable, an unsealed body bag may be used.

If necessary, administer benzodiazepines to control shivering.

Remove the patient once core temperature reaches 39°C to avoid overshoot hypothermia.

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