Author(s): TAN, X., LEE, J.K.W., Institution: NATIONAL UNIVERSITY OF SINGAPORE, Country: SINGAPORE, Abstract-ID: 1574

INTRODUCTION:
Exertional heat stroke is one of the leading causes of sudden death in sports. Effective heat stroke emergency responses and management are thus vital. The archetypal features of heat stroke are the presence of high body temperature and neurological symptoms indicative of central nervous system dysfunction [1]. Our brain is a critical organ susceptible to functional impairments and potentially irreversible injuries when one succumbs to heat stroke. Existing guidelines for first aid response to heat stroke focus on rapid body cooling but overlook the importance of cooling the brain. Therefore, we aimed to summarise the current evidence on the impact of heat on brain function and related mechanisms, and to explore the relevance of brain cooling as first aid response to heat stroke.
METHODS:
We employed a thematic approach where literature was identified based on relevance to the key questions: (1) How is the human brain affected by heat? (2) What are the mechanisms of heat-related brain functional impairment? (3) Is there evidence supporting brain cooling approach? An iterative search of databases (e.g., PubMed, Web of Science) was conducted to identify studies relevant to heat stroke management and brain cooling.
RESULTS:
Studies have shown that our brain is highly sensitive to thermal stress where increased temperatures impair brain function through neuronal and glial dysfunction, loss of blood-brain-barrier integrity and reduced cerebral perfusion and oxygenation. Impaired thermoregulation due to brain dysfunction can lead to uncontrolled hyperthermia and poor outcomes from heat stroke. Head-cooling intervention via forced convective cooling or cooling cap has been demonstrated to significantly reduce brain temperature and improve neural function.
CONCLUSION:
We advocate early brain cooling, in addition to whole-body cooling, to be considered as part of heat stroke first aid protocols for neuroprotection. This strategy may promote quicker functional recovery, minimise irreversible brain tissue damage, and reduce neurological complications in heat stroke.

Reference:
[1] Bouchama A, Abuyassin B, Lehe C, Laitano O, Jay O, O’Connor FG, Leon LR: Classic and exertional heatstroke. Nature Reviews Disease Primers 2022, 8(1):8.