ST elevation myocardial infarction oxygen therapy: Difference between revisions
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===Mechanism of Benefit=== | ===Mechanism of Benefit=== | ||
[[Oxygen]] is administered to the vast majority of patients with [[ST elevation myocardial infarction]] ([[STEMI]]). There is limited data to suggest that supplemental [[oxygen]] improves ST segment resolution (a surrogate endpoint)<ref name="pmid1253359">{{cite journal |author=Madias JE, Hood WB |title=Reduction of precordial ST-segment elevation in patients with anterior myocardial infarction by oxygen breathing |journal=Circulation |volume=53 |issue=3 Suppl |pages=I198–200 |year=1976 |month=March |pmid=1253359 |doi= |url=}}</ref> 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<ref name="pmid5444451">{{cite journal |author=Fillmore SJ, Shapiro M, Killip T |title=Arterial oxygen tension in acute myocardial infarction. Serial analysis of clinical state and blood gas changes |journal=Am. Heart J. |volume=79 |issue=5 |pages=620–9 |year=1970 |month=May |pmid=5444451 |doi= |url=}}</ref> | [[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)<ref name="pmid1253359">{{cite journal |author=Madias JE, Hood WB |title=Reduction of precordial ST-segment elevation in patients with anterior myocardial infarction by oxygen breathing |journal=Circulation |volume=53 |issue=3 Suppl |pages=I198–200 |year=1976 |month=March |pmid=1253359 |doi= |url=}}</ref> 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<ref name="pmid5444451">{{cite journal |author=Fillmore SJ, Shapiro M, Killip T |title=Arterial oxygen tension in acute myocardial infarction. Serial analysis of clinical state and blood gas changes |journal=Am. Heart J. |volume=79 |issue=5 |pages=620–9 |year=1970 |month=May |pmid=5444451 |doi= |url=}}</ref> | ||
==Clinical Trial Data== | ==Clinical Trial Data== | ||
Large scale randomized clinical trial data is lacking regarding its impact on mortality or other hard clinical endpoints. | 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 <ref> 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 <ref/>. | ||
===Dosing=== | ===Dosing=== | ||
Revision as of 12:54, 16 June 2010
| Myocardial infarction | |
| ICD-10 | I21-I22 |
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Oxygen
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 ==
| “ |
Class I1. Supplemental oxygen should be administered to patients with arterial oxygen desaturation (SaO2 less than 90%). (Level of Evidence: B) Class IIa1. 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 [3]
- The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [4]
References
- ↑ 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) - ↑ 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) - ↑ 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) - ↑ 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. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. Unknown parameter
|month=ignored (help)