University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.
Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts.
West J Emerg Med. 2021 Feb 26;22(2):186-195. doi: 10.5811/westjem.2020.11.49007.
Climate change is causing an increase in the frequency and intensity of extreme heat events, which disproportionately impact the health of vulnerable populations. Heatstroke, the most serious heat-related illness, is a medical emergency that causes multiorgan failure and death without intervention. Rapid recognition and aggressive early treatment are essential to reduce morbidity and mortality. The objective of this study was to evaluate current standards of care for the emergent management of heatstroke and propose an evidence-based algorithm to expedite care.
We systematically searched PubMed, Embase, and key journals, and reviewed bibliographies. Original research articles, including case studies, were selected if they specifically addressed the recognition and management of heatstroke in any prehospital, emergency department (ED), or intensive care unit population. Reviewers evaluated study quality and abstracted information regarding demographics, scenario, management, and outcome.
In total, 63 articles met full inclusion criteria after full-text review and were included for analysis. Three key themes identified during the qualitative review process included recognition, rapid cooling, and supportive care. Rapid recognition and expedited external or internal cooling methods coupled with multidisciplinary management were associated with improved outcomes. Delays in care are associated with adverse outcomes. We found no current scalable ED alert process to expedite early goal-directed therapies.
Given the increased risk of exposure to heat waves and the time-sensitivity of the condition, EDs and healthcare systems should adopt processes for rapid recognition and management of heatstroke. This study proposes an evidence-based prehospital and ED heat alert pathway to improve early diagnosis and resource mobilization. We also provide an evidence-based treatment pathway to facilitate efficient patient cooling. It is hoped that this protocol will improve care and help healthcare systems adapt to changing environmental conditions.
气候变化导致极端高温事件的频率和强度不断增加，这对弱势群体的健康造成了不成比例的影响。中暑是最严重的与热相关的疾病，如果不干预，会导致多器官衰竭和死亡。快速识别和积极的早期治疗对于降低发病率和死亡率至关重要。本研究的目的是评估中暑紧急管理的当前标准护理，并提出一个基于证据的算法来加快护理速度。
我们系统地搜索了 PubMed、Embase 和主要期刊，并审查了参考文献。如果原始研究文章专门针对任何院前、急诊部 (ED) 或重症监护病房人群的中暑识别和管理，则选择这些文章。审查员评估了研究质量，并摘录了有关人口统计学、情况、管理和结果的信息。
经过全文审查，共有 63 篇文章符合全部纳入标准，并被纳入分析。在定性审查过程中确定了三个关键主题，包括识别、快速降温以及支持性护理。快速识别和加速外部或内部冷却方法以及多学科管理与改善结果相关。护理延迟与不良结果相关。我们没有发现当前可扩展的 ED 警报流程来加速早期目标导向治疗。
鉴于暴露于热浪的风险增加以及病情的时间敏感性，ED 和医疗保健系统应采用快速识别和管理中暑的流程。本研究提出了一个基于证据的院前和 ED 热警报途径，以改善早期诊断和资源动员。我们还提供了一个基于证据的治疗途径，以促进有效的患者降温。希望本方案能够改善护理，并帮助医疗保健系统适应不断变化的环境条件。
