Cold Water Immersion for Medical Indications

Heat Stroke Treatment

The American College of Critical Care Medicine recommends cold-water or ice-water immersion as the gold standard treatment for heat stroke, which should be initiated immediately without delay, for patients with core temperature >40°C and CNS abnormalities 1
Active cooling methods are strongly recommended over passive cooling for patients with core temperature >40°C and CNS abnormalities, with ice-water immersion achieving the fastest cooling rate 1
Ice-water immersion (1°C–5°C/33.8°F–41.0°F) is prioritized where available, while cold-water immersion (14°C–15°C/57.2°F–59°F) is effective when ice-water is unavailable 2
In young, healthy individuals with exertional heat stroke, ice-water immersion showed 0% mortality in multiple studies, according to the Critical Care society 3, 4, 5
However, in elderly patients (mean age 71 years) with comorbidities, ice-water immersion resulted in 14.3% mortality and 14.3% severe brain damage, and was poorly tolerated, as reported by the Critical Care society 3, 4

The Critical Care Medicine society recommends considering patient age and comorbidities when deciding on ice-water immersion for heat stroke treatment, with elderly patients tolerating poorly 3, 4
The American College of Critical Care Medicine suggests immediate ice-water immersion (1-5°C) as the priority intervention for heat stroke, over all other interventions 1

The American Heart Association recommends application of cold (ice and water in a damp cloth) for pain and swelling, limiting cold application to 20-30 minutes per session to avoid cold injury, and avoiding direct contact with skin to prevent cold-related tissue damage 6.

The American Heart Association notes that risk of hypothermia exists, particularly with longer immersion times or very cold water temperatures 7.

The American College of Critical Care Medicine recommends active cooling methods over passive cooling for patients with heat stroke 8.
The American Heart Association recommends cold water immersion (14°C–15°C/57.2°F–59°F) of the torso for faster core body temperature reduction compared to passive cooling, and ice water immersion (1°C–5°C/33.8°F–41.0°F) for rapid cooling in exertional heat stroke 7.
The American Heart Association also suggests that ice water immersion is effective for rapid cooling in exertional heat stroke 9.
The International Sports Medicine society notes that immediate cooling is critical for preventing mortality and neurological damage in heat stroke 10.