A retrospective case series evaluated an ice-water-soaked sheet protocol (2.0×2.5 m sheets at 3–8°C, replaced every 4–5 min) versus cold-water immersion (CWI) for cooling exertional heat stroke (EHS) patients in the ED between May 2022 and July 2024.
Ice-water sheet coverage achieved a mean cooling rate of 0.09°C/min vs. 0.12°C/min for CWI; all 25 patients reached <39.0°C within 30 min and <38.5°C within 45.3±10.2 min. Cooling initiation was faster with sheets (5.2±1.8 min) than CWI (8.5±1.3 min). No frostbite, severe arrhythmia, or deaths occurred; mild shivering in 20% was managed with low-dose sedation.
- Very small sample (n=25, all male), limiting generalizability. - Retrospective design with no randomization; group allocation likely driven by clinical factors, introducing selection bias. - Single-center experience; no long-term follow-up data reported.
When CWI is not feasible in the ED (e.g., intubated or actively resuscitated patients), ice-water sheet coverage can be initiated faster and still achieves clinically effective cooling without compromising IV access or monitoring. Consider this protocol as a practical bridge or alternative when immersion tubs are unavailable.
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