{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T07:02:31Z","timestamp":1780038151573,"version":"3.53.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exertional heat stroke (EHS) and exercise-induced hyperthermia require rapid reduction of core temperature (Tc). Portable active cooling devices are uesed in field settings where cold-water immersion (the gold standard) is not feasible, but their efficacy compared to passive cooling remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This review and analysis compared cooling rates between portable active cooling and passive cooling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta-analysis (PRISMA 2020, PROSPERO: CRD420261292698) of randomized and crossover trials. Eligible studies compared portable active cooling (type A: external refrigerant-based cooling systems; type B: wearable pre-cooling systems) with passive cooling in adults with exercise-induced hyperthermia. The primary outcome was mean Tc cooling rate (\u00b0C\/min), analyzed using a random-effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      11 trials (\n                      <jats:italic>n<\/jats:italic>\n                      = 148 participants) were included. Portable active cooling produced a significantly faster cooling rate than passive cooling (MD = 0.02 \u00b0C\/min, 95% CI: 0.01 to 0.03,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.00001). Subgroup analysis revealed that type A devices had superior cooling efficacy (MD = 0.04 \u00b0C\/min, 95% CI: 0.02\u20130.04), particularly when ambient temperature exceeded 30 \u00b0C. In contrast, type B devices showed no significant advantage (MD = 0.00 \u00b0C\/min).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For field management of exertional heat stroke or severe exercise-induced hyperthermia, portable active cooling systems that use external refrigerant-based cooling (type A) are more effective than passive cooling. Wearable pre-cooling systems (type B) do not demonstrate superior efficacy. Selection of cooling devices should prioritize cooling mechanism over mere portability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261292698<\/jats:ext-link>\n                      , identifier: CRD420261292698.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1811173","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:10:00Z","timestamp":1780035000000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative efficacy of portable active cooling vs. passive cooling for reducing core temperature in exertional heat stroke: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Chuankai","family":"Shi","sequence":"first","affiliation":[{"name":"Department of Graduate School, Xinjiang Medical University","place":["Urumqi, China"]},{"name":"Desert Medicine Laboratory, General Hospital of Xinjiang Military Command","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taimin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of External Medicine II, Xinjiang Corps Hospital of the Chinese People's Armed Police Force","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"Shi","sequence":"additional","affiliation":[{"name":"Desert Medicine Laboratory, General Hospital of Xinjiang Military Command","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinquan","family":"Qu","sequence":"additional","affiliation":[{"name":"Desert Medicine Laboratory, General Hospital of Xinjiang Military Command","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laiyang","family":"Song","sequence":"additional","affiliation":[{"name":"Desert Medicine Laboratory, General Hospital of Xinjiang Military Command","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangwei","family":"Liu","sequence":"additional","affiliation":[{"name":"Desert Medicine Laboratory, General Hospital of Xinjiang Military Command","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"B1","first-page":"90","article-title":"Diagnosis and management of heatstroke","volume":"52","author":"Asmara","year":"2020","journal-title":"Acta Med Indones."},{"key":"B2","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1038\/s41572-021-00334-6","article-title":"Classic and exertional heatstroke","volume":"8","author":"Bouchama","year":"2022","journal-title":"Nat Rev Dis Primers."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e327","DOI":"10.1016\/j.jemermed.2024.04.005","article-title":"Casa DJ. Exertional heat stroke best practices in US emergency medical services guidelines","volume":"67","author":"Tishukaj","year":"2024","journal-title":"J Emerg Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1038\/s41558-024-02137-5","article-title":"Rising cause-specific mortality risk and burden of compound heatwaves amid climate change","volume":"14","author":"Liu","year":"2024","journal-title":"Nat Clim Change"},{"key":"B5","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1007\/s00011-022-01687-8","article-title":"Inflammation, coagulation, and cellular injury in heat-induced shock","volume":"72","author":"Iba","year":"2023","journal-title":"Inflammation Research."},{"key":"B6","doi-asserted-by":"publisher","first-page":"530","DOI":"10.13604\/j.cnki.46-1064\/r.2025-1731","article-title":"Progress in molecular mechanisms and pathophysiology of heat stroke","volume":"26","author":"Liu","year":"2026","journal-title":"China Trop Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"734","DOI":"10.3390\/nu12030734","article-title":"Beyond heat stress: intestinal integrity disruption and mechanism-based intervention strategies","volume":"12","author":"Lian","year":"2020","journal-title":"Nutrients."},{"key":"B8","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s13054-024-05006-x","article-title":"Gut-derived immune cells and the gut-lung axis in ards","volume":"28","author":"Ziaka","year":"2024","journal-title":"Crit Care."},{"key":"B9","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1002\/j.2040-4603.2015.tb00612.x","article-title":"Heat stroke","volume":"5","author":"Leon","year":"2015","journal-title":"Compr Physiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.jemermed.2019.08.033","article-title":"Intestinal injury in heat stroke","volume":"57","author":"Ye","year":"2019","journal-title":"J Emerg Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1038\/s41420-024-02210-0","article-title":"The mechanisms behind heatstroke-induced intestinal damage","volume":"10","author":"Sun","year":"2024","journal-title":"Cell Death Discov."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1286556","DOI":"10.3389\/fphar.2023.1286556","article-title":"The Pathogenesis and therapeutic strategies of heat stroke-induced myocardial injury","volume":"14","author":"Xia","year":"2023","journal-title":"Front Pharmacol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.ajem.2022.08.042","article-title":"Usefulness of sequential organ failure assessment score on admission to predict the 90-day mortality in patients with exertional heatstroke: an over 10-year intensive care survey","volume":"61","author":"Zhong","year":"2022","journal-title":"Am J Emerg Med."},{"key":"B14","unstructured":"Chinese guideline for the diagnosis and treatment of heatstroke (2025 edition)\n          \n          367\n          86\n          \n            \n              Jingchun\n              Song\n            \n            \n              Qing\n              Song\n            \n            \n              Wei\n              Zhang\n            \n            \n              Weiqin\n              Li\n            \n            \n              Xijing\n              Zhang\n            \n            \n              Shuyuan\n              Liu\n            \n          \n          Mil Med Res.\n          50\n          2025"},{"key":"B15","unstructured":"Expert consensus on cooling methods for preventing heat illness\/stroke in military training\n          \n          871\n          8\n          Mil Med Res.\n          48\n          2023"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00421-023-05276-3","article-title":"Century of exercise physiology: concepts that ignited the study of human thermoregulation. part 3: heat and cold tolerance during exercise","volume":"124","author":"Notley","year":"2024","journal-title":"Eur J Appl Physiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"108","DOI":"10.3389\/fphys.2019.00108","article-title":"Inconsistency in the standard of care-toward evidence-based management of exertional heat stroke","volume":"10","author":"Hosokawa","year":"2019","journal-title":"Front Physiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1111\/sms.12676","article-title":"Successful out-of-hospital therapy for heatstroke in three marathon runners with a novel core body cooling device: Caervest(\u00ae)","volume":"26","author":"Gomm","year":"2016","journal-title":"Scand J Med Sci Sports."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.1155\/er\/3489021","article-title":"Emerging passive cooling technologies and their multidisciplinary applications: an integrative review","author":"Nqoro","year":"2025","journal-title":"Int J Energy Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The prisma","volume":"372","author":"Page","year":"2021","journal-title":"Bmj."},{"key":"B21","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1177\/0145445516673998","article-title":"Intercoder reliability and validity of webplotdigitizer in extracting graphed data","volume":"41","author":"Drevon","year":"2017","journal-title":"Behav Modif."},{"key":"B22","doi-asserted-by":"publisher","first-page":"Ed000142","DOI":"10.1002\/14651858.ED000142","article-title":"Updated guidance for trusted systematic reviews: a new edition of the cochrane handbook for systematic reviews of interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst Rev."},{"key":"B23","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"Bmj."},{"key":"B24","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s12915-017-0357-7","article-title":"Meta-evaluation of meta-analysis: ten appraisal questions for biologists","volume":"15","author":"Nakagawa","year":"2017","journal-title":"BMC Biol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"Bmj."},{"key":"B26","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1016\/j.jclinepi.2007.11.010","article-title":"Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry","volume":"61","author":"Peters","year":"2008","journal-title":"J Clin Epidemiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in Meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"Bmj."},{"key":"B28","doi-asserted-by":"publisher","first-page":"d4002","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials","volume":"343","author":"Sterne","year":"2011","journal-title":"Bmj."},{"key":"B29","doi-asserted-by":"publisher","first-page":"55","DOI":"10.4085\/1062-6050-43.1.55","article-title":"Thermoregulatory influence of a cooling vest on hyperthermic athletes","volume":"43","author":"Lopez","year":"2008","journal-title":"J Athl Train."},{"key":"B30","doi-asserted-by":"publisher","first-page":"300","DOI":"10.3109\/10903121003770654","article-title":"Comparison of active cooling devices with passive cooling for rehabilitation of firefighters performing exercise in thermal protective clothing: a report from the fireground rehab evaluation (fire) trial","volume":"14","author":"Hostler","year":"2010","journal-title":"Prehosp Emerg Care."},{"key":"B31","doi-asserted-by":"publisher","first-page":"164","DOI":"10.4085\/1062-6050-45.2.164","article-title":"Postexercise cooling rates in 2 cooling jackets","volume":"45","author":"Brade","year":"2010","journal-title":"J Athl Train."},{"key":"B32","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.1519\/JSC.0b013e3182259b1d","article-title":"Comparison of body cooling methods on physiological and perceptual measures of mildly hyperthermic athletes","volume":"25","author":"DeMartini","year":"2011","journal-title":"J Strength Cond Res."},{"key":"B33","doi-asserted-by":"publisher","first-page":"946","DOI":"10.4085\/1062-6050-51.12.07","article-title":"Cooling effectiveness of a modified cold-water immersion method after exercise-induced hyperthermia","volume":"51","author":"Luhring","year":"2016","journal-title":"J Athl Train."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e1951","DOI":"10.7205\/MILMED-D-17-00057","article-title":"Effectiveness of ice-sheet cooling following exertional hyperthermia","volume":"182","author":"Butts","year":"2017","journal-title":"Mil Med."},{"key":"B35","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.annemergmed.2016.08.428","article-title":"Tarp-assisted cooling as a method of whole-body cooling in hyperthermic individuals","volume":"69","author":"Hosokawa","year":"2017","journal-title":"Ann Emerg Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"539","DOI":"10.3390\/medicina56100539","article-title":"Chemically activated cooling vest's effect on cooling rate following exercise-induced hyperthermia: a randomized counter-balanced crossover study","volume":"56","author":"Hosokawa","year":"2020","journal-title":"Medicina."},{"key":"B37","doi-asserted-by":"publisher","first-page":"e1017","DOI":"10.1093\/milmed\/usac047","article-title":"The effectiveness of a standardized ice-sheet cooling method following exertional hyperthermia","volume":"187","author":"Caldwell","year":"2022","journal-title":"Mil Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"103576","DOI":"10.1016\/j.jtherbio.2023.103576","article-title":"Phase-change material cooling blanket: a feasible cooling choice during transport after exercise-induced hyperthermia","volume":"114","author":"Wang","year":"2023","journal-title":"J Therm Biol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"104130","DOI":"10.1016\/j.jtherbio.2025.104130","article-title":"Evaluation of a lightweight water circulation cooling blanket for the prevention of exertional heat stroke","volume":"129","author":"Li","year":"2025","journal-title":"J Therm Biol."},{"key":"B40","first-page":"15","article-title":"Sports medicine: exertional heat illness","volume":"482","author":"O'Connor","year":"2019","journal-title":"FP Essent."},{"key":"B41","doi-asserted-by":"publisher","first-page":"155134","DOI":"10.1016\/j.jcrc.2025.155134","article-title":"What every intensivist should know about exertional heat stroke","volume":"89","author":"Stomeo","year":"2025","journal-title":"J Crit Care."},{"key":"B42","doi-asserted-by":"publisher","first-page":"695","DOI":"10.3390\/biology12050695","article-title":"A systematic review of post-work core temperature cooling rates conferred by passive rest","volume":"12","author":"Brearley","year":"2023","journal-title":"Biology."},{"key":"B43","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1080\/00140130903581649","article-title":"Cooling vests with phase change material packs: the effects of temperature gradient, mass and covering area","volume":"53","author":"Gao","year":"2010","journal-title":"Ergonomics."},{"key":"B44","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1123\/jsr.2015-0082","article-title":"Should cooling vests be used to treat exertional heatstroke? a critically appraised topic","volume":"26","author":"Keen","year":"2017","journal-title":"J Sport Rehabil."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1113\/EP087718","article-title":"Cold-induced cutaneous vasoconstriction in humans: function, dysfunction and the distinctly counterproductive","volume":"104","author":"Alba","year":"2019","journal-title":"Exp Physiol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1080\/23328940.2015.1088502","article-title":"Arterio-venous anastomoses in the human skin and their role in temperature control","volume":"3","author":"Wall\u00f8e","year":"2016","journal-title":"Temperature."},{"key":"B47","doi-asserted-by":"publisher","first-page":"031203","DOI":"10.1115\/1.4053195","article-title":"Bioheat transfer basis of human thermoregulation: principles and applications","volume":"144","author":"Namisnak","year":"2022","journal-title":"J Heat Transfer."},{"key":"B48","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.jtherbio.2014.09.003","article-title":"Responses in acral and non-acral skin vasomotion and temperature during lowering of ambient temperature","volume":"45","author":"Elstad","year":"2014","journal-title":"J Therm Biol."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1811173\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:10:05Z","timestamp":1780035005000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1811173\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":48,"alternative-id":["10.3389\/fpubh.2026.1811173"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1811173","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]},"article-number":"1811173"}}