ABSTRACT Exertional heat illness represents a critical yet preventable cause of morbidity and mortality in athletic populations globally, with exertional heat stroke (EHS) ranking as the third leading cause of sudden death in sports. This narrative review synthesizes current evidence-based prevention and treatment strategies, offering analytical insights into implementation challenges across diverse athletic and climatic settings. The pathophysiology involves thermoregulatory failure, systemic inflammatory cascades including novel interleukin-6 pathways identified in 2023–2024 studies, intestinal barrier dysfunction with endotoxemia, and coagulopathy culminating in multiorgan failure. Core prevention strategies include structured 10–14-day heat acclimatization protocols achieving 95% reduction in EHS deaths following National Collegiate Athletic Association guideline implementation, individualized hydration practices maintaining body weight loss ≤2%, and activity modification guided by wet-bulb globe temperature thresholds adapted to regional climates. Cold water immersion therapy remains the gold standard treatment, achieving 100% survival rates when initiated within 30 min in well-controlled settings with cooling rates of 0.15°C–0.35°C/min. The “cool first, transport second” paradigm represents the current standard of care. This review distinguishes evidence-based interventions from expert consensus recommendations, identifies implementation barriers including equipment costs and personnel training, and addresses regional climate adaptations. Future research priorities include molecular biomarkers for heat tolerance prediction, artificial intelligence-driven monitoring systems, and precision medicine approaches. Comprehensive implementation of multicomponent programs emphasizing acclimatization, environmental monitoring, and emergency preparedness can transform EHS from a leading cause of athletic mortality to a fully preventable condition.
Ahmed Abdulaziz Almohammadi (Thu,) studied this question.