Guideline for the Treatment of Heat Stroke

Jeffrey F. Barletta, PharmD, FCCP, FCCM Heatherlee Bailey, MD, FAAEM, MCCM

PUBLISHED: 02/21/2025

Guideline for the Treatment of Heat Stroke

Citation: Barletta JF, Palmieri TL, Toomey SA, et al. Society of Critical Care Medicine guideline for the treatment of heat stroke. Crit Care Med. 2025;53(2):e490-e500.

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Predicted increases in heat-related weather phenomena will result in increasing heat exposures and heat injuries such as heat stroke. Prompt recognition, early intervention, and evidence-based management are necessary to optimize outcomes. These SCCM guidelines outline recommendations for the treatment of patients with heat stroke.

The guidelines panel generated two strong recommendations, five good practice statements and one “only-in-the-context of research” statement. Active cooling measures are recommended over passive cooling methods, with cold- or ice-water immersion achieving the fastest cooling rate. This method should be prioritized where available. In patients with heat stroke, there is no evidence to support pharmacological interventions that affect temperature control, so they should be avoided.

Guideline Type: Clinical

Related Resources:

Infographic: 2025 SCCM Guideline for the Treatment of Heat Stroke

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We recommend active cooling methods over passive cooling in patients with heat stroke.
Quality of evidence: Very low

Cooling modalities Strong Cooling method

Clinicians should prioritize cooling methods that achieve the most rapid rate of cooling. This includes ice-water immersion (1-5 °C) or cold-water immersion (9-12 °C).

Cooling modalities Good practice statement Cooling method

Clinicians may use similar strategies for either classic or exertional heat stroke.

Cooling modalities Good practice statement Cooling strategies

Clinicians should choose cooling methods that reach the target temperature within 30 minutes from recognition of heat stroke symptoms.

Cooling modalities Good practice statement Target temperature

Clinicians should prioritize cooling modalities that achieve a cooling rate greater than or equal to 0.155 ° C/min.

Cooling modalities Good practice statement Cooling rate

We recommend against the use of dantrolene in patients with heat stroke.
Quality of evidence: Very low

Medications that affect temperature control Strong Dantrolene

The routine use of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS), and salicylates for temperature reduction should be avoided.

Medications that affect temperature control Good practice statement Anti-inflammatory drugs

Prophylactic antibiotics or prophylactic antiseizure medications should only be used in the context of research.

Medications that affect temperature control Only-in-the-context of research statement Prophylactic medications

Author

Jeffrey F. Barletta, PharmD, FCCP, FCCM

Jeffrey F. Barletta, PharmD, FCCP, FCCM, is a professor and vice chair of pharmacy practice at Midwestern University (MWU) College of Pharmacy. Prior to joining MWU, Dr. Barletta was a clinical specialist in surgical critical care at Spectrum Health in Grand Rapids, Michigan, USA, and Detroit Receiving Hospital in Detroit, Michigan, USA. He has more than 20 years of experience in critical care and is currently a member of the American Board of Internal Medicine, Critical Care Medicine Board , and SCCM’s Council.

Author

Heatherlee Bailey, MD, FAAEM, MCCM

Heatherlee Bailey, MD, FAAEM, MCCM, is an emergency medicine intensivist. She completed her emergency medicine residency and a faculty fellowship in critical care at the Medical College of Pennsylvania in Philadelphia. Her career is rooted in education, trainee development, and mentorship. Her dedication and expertise have been nationally recognized with awards from both SCCM and the AMA. Dr. Bailey serves as an oral board examiner for the American Board of Emergency Medicine. Dr. Bailey’s path of volunteerism, mentorship, and leadership led her to be the first emergency medicine-trained president of SCCM.

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