Heat stroke is a critical and health-threatening disease, which progresses rapidly and leads systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), results in a high mortality rate. Nearly 30% of survivors will get neurological sequelae. Active cooling, which called the ″first key point″, is crucial in the traditionally heatstroke treatment. However, recent studies have found that in addition to cooling, active strategies for organ damage prevent single organ damage from developing to MODS is critical for better outcome in patients with heat stroke. Based on these, ″second key point hypothesis″ is put forward and a series of new treatment strategies have been developed gradually during the past decade. However, there is still a lack of standardized and unified clinical protocol for severe heat stroke, and the efficacy of some treatments is not yet clear. In this review, we talk about the cooling and systemic organ support which focusing on ″the first and the second key points″, conclude the current situation and research progress of the treatment strategies for severe heat stroke in clinical practice in recent years, so as to provide reference for standard management and further study.