ST elevation myocardial infarction oxygen therapy
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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.
ACC/AHA Guidelines (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
References
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