Table 4 Summary of data on cooling methods based on evaporation in the treatment of classic heatstroke

[25] (U.S., 1986)

Classic heatstroke

(n = 14)

Case series

Ice to the lateral aspect of the trunk and spraying of tepid water (40°C); fan directed to patients; massage to torso and neck; chilled intravenous solution; target T_rect: ≤ 39.4°C

Cooling time; mortality; morbidity

Median (range) cooling time: 60 minutes (34 to 89 minutes); mortality: 7.1%; neurologic morbidity: 0%

Combination of several cooling techniques; relative contribution of each difficult to ascertain

[27] (Saudi Arabia, 1987)

Classic heatstroke

(n = 25)

Case series

Wet gauze sheet with water at 20°C; fan with speed airflow of 2.6 m/s; target T_rect: ≤ 39°C

Cooling time; mortality; morbidity

Mean (range) cooling time: 40.4 minutes (20 to 145 minutes); mortality: 0%; morbidity: 24%

No follow-up

[22] (Kuwait, 1980)

Classic heatstroke

(n = 18)

Case series

Body cooling unit*; target T_rect: < 38°C

Cooling time; mortality;

Cooling time: 26 to 300 minutes; mortality: 11.1%

No follow-up

[23] (Kuwait, 1981)

Classic heatstroke

(n = 174)

Case series

Body cooling unit*; target T_rect: < 38°C

Cooling time; mortality;

Mean (range) cooling time: 78 minutes (20 to 180 minutes); mortality: 14.9%

No follow-up

[26] (Saudi Arabia, 1986)

Classic heatstroke

(n = 16)

Randomized controlled trial

Evaporative cooling using body cooling unit* (n = 8) versus conventional method (wet gauze sheet with water at 25°C and fanning air at 20°C) (n = 8); body cooling unit*; target T_rect: ≤ 38.5°C

Cooling time; mortality; morbidity

No significant difference in cooling time; no death in either group; neurologic morbidity: 25% versus 12.5%

Small sample size; randomization method not specified; no follow-up