ST elevation myocardial infarction oxygen therapy

Jump to: navigation, search

Acute Coronary Syndrome Main Page

ST Elevation Myocardial Infarction Microchapters

Home

Patient Information

Overview

Pathophysiology

Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Gross Pathology
Histopathology

Causes

Differentiating ST elevation myocardial infarction from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History and Complications

Risk Stratification and Prognosis

Pregnancy

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Chest X Ray

Cardiac MRI

Echocardiography

Coronary Angiography

Treatment

Pre-Hospital Care

Initial Care

Oxygen
Nitrates
Analgesics
Aspirin
Beta Blockers
Antithrombins
The coronary care unit
The step down unit
STEMI and Out-of-Hospital Cardiac Arrest
Pharmacologic Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Fibrinolysis
Reperfusion at a Non–PCI-Capable Hospital:Recommendations
Mechanical Reperfusion
The importance of reducing Door-to-Balloon times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
CABG
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin therapy
Unfractionated heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT prophylaxis
Long term anticoagulation
Antiplatelet Agents
Aspirin
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
Lipid Management

Pre-Discharge Care

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post Hospitalization Plan of Care

Long-Term Medical Therapy and Secondary Prevention

Overview
Inhibition of the Renin-Angiotensin-Aldosterone System
Cardiac Rehabilitation
Pacemaker Implantation
Long Term Anticoagulation
Implantable Cardioverter Defibrillator
ICD implantation within 40 days of myocardial infarction
ICD within 90 days of revascularization

Case Studies

Case #1

Case #2

Case #3

Case #4

Case #5

ST elevation myocardial infarction oxygen therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on ST elevation myocardial infarction oxygen therapy

CDC on ST elevation myocardial infarction oxygen therapy

ST elevation myocardial infarction oxygen therapy in the news

Blogs on ST elevation myocardial infarction oxygen therapy

Directions to Hospitals Treating ST elevation myocardial infarction

Risk calculators and risk factors for ST elevation myocardial infarction oxygen therapy

Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] and Tom Quinn, FRCN, FESC [2]

Overview

Oxygen therapy is commonly used within the STEMI patient population. Theoretical models suggest that the usage of oxygen therapy can influence the ventilation perfusion mismatch which occurs early on in the patient's course of disease. Randomized clinical data to support this therapy is still lacking.

Oxygen Therapy

Mechanism of Benefit

Oxygen is administered to the vast majority (98%) of patients with ST elevation myocardial infarction (STEMI). There is limited data to suggest that supplemental oxygen improves ST segment resolution (a surrogate endpoint)[1] The theoretical basis for oxygen administration is also based on the fact that there may be ventilation perfusion mismatch early in the patient's course[2]

Clinical Trial Data

Large scale randomized clinical trial data is lacking regarding its impact on mortality or other hard clinical endpoints. A recent review of available trial data indicated no benefit of supplemental oxygen, and in fact there was signs of a hazard [3]. Three randomized trial have enrolled a total of 387 patients. There were 14 deaths. Oxygen administration was associated with non-significant 2.88 fold increase in mortality (95% CI 0.88-9.39). It should be emphasized that given the small numbers of deaths in the trials, the trend toward a hazard associated with oxygen could represent a play of chance, and was not statistically significant. Large randomized trials would be necessary to evaluate the risks and benefits of oxygen. Current guideline recommendations are based upon expert consensus, and not clinical trial data.

Dosing

In general oxygen is administered via nasal canula or face mask to patients with an uncomplicated course to maintain an oxygen saturation greater than 90%. However, endotracheal intubation may be required in those patients with a clinical course complicated by severe pulmonary edema, cardiogenic shock or mechanical complications (e.g. papillary muscle rupture, free wall rupture, or acquired ventricular septal defect).

Side Effects

While the majority of patients may benefit from supplemental oxygen administration, excess oxygen administration may be harmful to those patients with chronic obstructive pulmonary disease. Administration of oxygen to these patients should be judicious and guided by periodic arterial blood gas values.

2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (DO NOT EDIT) [4]

Class I
"1. Supplemental oxygen should be administered to patients with arterial oxygen desaturation (SaO2 less than 90%). (Level of Evidence: B) "
Class IIa
"1. It is reasonable to administer supplemental oxygen to all patients with uncomplicated STEMI during the first 6 hours. (Level of Evidence: C) "

Sources

  • The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [5]
  • The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [6]

References

  1. Madias JE, Hood WB (1976). "Reduction of precordial ST-segment elevation in patients with anterior myocardial infarction by oxygen breathing". Circulation. 53 (3 Suppl): I198–200. PMID 1253359.  Unknown parameter |month= ignored (help)
  2. Fillmore SJ, Shapiro M, Killip T (1970). "Arterial oxygen tension in acute myocardial infarction. Serial analysis of clinical state and blood gas changes". Am. Heart J. 79 (5): 620–9. PMID 5444451.  Unknown parameter |month= ignored (help)
  3. Cabello JB, Burls A, Emparanza JI, et al. Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev 2010; 6: CD007160. DOI: 10.1002/14651858.CD007160.pub2. Available at: http://www.cochrane.org/cochrane-reviews
  4. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M; et al. (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction).". Circulation. 110 (5): 588–636. PMID 15289388. doi:10.1161/01.CIR.0000134791.68010.FA. 
  5. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869.  Unknown parameter |month= ignored (help)
  6. Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. PMID 18071078. doi:10.1161/CIRCULATIONAHA.107.188209.  Unknown parameter |month= ignored (help)

Linked-in.jpg