Cold-water immersion and the treatment of hyperthermia: using 38.6°C as a safe rectal temperature cooling limit

J Athl Train. 2010 Sep-Oct;45(5):439-44. doi: 10.4085/1062-6050-45.5.439.


Context: Cold-water immersion is recommended for the immediate field treatment of exertional heat stroke. However, concerns exist over potential overcooling of hyperthermic individuals during cold-water immersion.

Objective: To evaluate the recommendation that removing previously hyperthermic individuals from a cold-water bath at a rectal temperature (T(re)) of 38.6°C would attenuate overcooling.

Design: Controlled laboratory study.

Setting: University research laboratory.

Patients or other participants: Participants included 6 men and 4 women (age = 22 ± 3 years, height = 172 ± 10 cm, mass = 67.8 ± 10.7 kg, body fat percentage = 17.1% ± 4.5%, maximum oxygen consumption = 59.3 ± 8.7 mL·kg(-1)·min(-1)).

Intervention(s): After exercising at an ambient temperature of 40.0°C for 38.5 ± 9.4 minutes, until T(re) reached 39.5°C, participants were immersed in a 2.0°C circulated water bath until T(re) decreased to either 37.5°C or 38.6°C. Subsequently, participants were removed from the water bath and recovered for 20 minutes at an ambient temperature of 25°C.

Main outcome measure(s): Rectal and esophageal temperatures were measured continuously during the immersion and recovery periods.

Results: Because of the experimental design, the overall time of immersion was greater during the 37.5°C trial (16.6 ± 5.7 minutes) than the 38.6°C trial (8.8 ± 2.6 minutes) (t(9) = -4.740, P = .001). During the recovery period after cold-water immersion, both rectal (F(1,9) = 50.540, P < .001) and esophageal (F(1,6) = 20.365, P = .007) temperatures remained greater in the 38.6°C trial than in the 37.5°C trial. This was evidenced by low points of 36.47°C ± 0.70°C and 37.19°C ± 0.71°C for rectal temperature (t(9) = 2.975, P = .016) and of 35.67°C ± 1.27°C and 36.72°C ± 0.95°C for esophageal temperature (t(6) = 3.963, P = .007) during the recovery period of the 37.5°C and 38.6°C trials, respectively.

Conclusions: Immersion for approximately 9 minutes to a rectal temperature cooling limit of 38.6°C negated any risk associated with overcooling hyperthermic individuals when they were immersed in 2°C water.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Temperature*
  • Cold Temperature*
  • Cryotherapy*
  • Female
  • Fever / therapy*
  • Heat Stroke / therapy
  • Humans
  • Immersion*
  • Male
  • Oxygen Consumption
  • Physical Exertion
  • Safety*