Oxygen in Normoxic STEMI – JC 26.08.2015

This week we discussed about the use of routine oxygen in normoxic STEMI patients. 

Background

  • Oxygen had been used routinely in the standard teaching of management of STEMI, even with the acronym of MONA being used – morphine, OXYGEN, nitrates and aspirin
  • There have been hypothesis and some evidence that shows that oxygen might bring harm and of little/no benefit
  • Chrocrane Review in 2013 review 4 trials involving 430 participants. Author concluded there is no conclusive evidence and suggested to have a randomised controlled trial to answer this clinical question

Discussions

  • The primary outcome for this study is a surrogate marker for infarct size which is a surrogate marker for clinical outcome 
  • The study is not powered to look at the adverse event outcome (mortality, recurrent MI & major arrthymias)
  • Usage of oxygen (as well as fluids) have not being judicious and should be treated like any other drugs as it is not without side effects/adverse effects
  • The initial 638 patients were not analysed as per intention to treat a good number were excluded from analysis
  • Guidelines from reputable AHA and ESC have recommended not to use oxygen routinely
  • Currently we have fewer cases seen in EU after the fast track system of STEMI patients from prehospital directly to cath lab
  • Excessive, non purposeful oxygen usage (might even harmful) may have significant cost impact

Other papers/sources worth looking at

  • NHS Formulary on Oxygen
  • Troponin for the Estimation of Infart Size : What Have We Learned? (Attached)
  • Quantification of Infarct Size (Attached)
  • Revisiting the Role of Oxygen Therapy in Cardiac Patients (Attached)
  • BTS Guideline on Emergency Oxygen used in adult patients (Attached)

How are we going forward

  • Oxygen usage to be tailored to the clinical needs as suggested by STEMI guidelines
  • Cost analysis and economic burden of excessive non purposeful usage of oxygen study

The related documents and presentation is available at the dropbox folder. Have an enjoyable read 🙂

Nic Ngua

*Disclaimer : The opinions expressed by the finetuningem’s author/editor and those providing comments are theirs alone, and do not reflect the opinions of any professional organisation or group or any employee thereof.

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