Comments on: STEMI Redux

By: Oxygen Heresy | Street Watch: Notes of a Paramedic

Oxygen Heresy | Street Watch: Notes of a Paramedic — Fri, 20 Nov 2009 13:09:55 +0000

[...] comment section of my recent STEMI Redux post produded a discussion about the use of high-flow oxygen in the setting of an MI, thus spuring [...]

By: John

John — Fri, 20 Nov 2009 04:29:20 +0000

Great post! Sexy 12lead (yes, I’m a sick cardiac PHREAK).

Chad…I’m sorry, but please remove head from butt before deciding you want to insult someone who actually knows what they are talking about.

Please remember… it is about what is doing what is *right* for the patient, not performing skills just because you can.

By: EMT

EMT — Fri, 20 Nov 2009 02:57:24 +0000

why didn’t you go nuts on treating this pt?

Whacker. You’re learning from a professional here. You’d be much better of reading quietly and contemplating. Hopefully you’ll learn something.

By: medicscribe

medicscribe — Thu, 19 Nov 2009 02:57:40 +0000

Hi Darrin-

Thanks for the question. Here is the citation:

Heart. 2009 Mar;95(3):198-202. Epub 2008 Aug 15.

Routine use of oxygen in the treatment of myocardial infarction: systematic review.
Wijesinghe M, Perrin K, Ranchord A, Simmonds M, Weatherall M, Beasley R.

Medical Research Institute of New Zealand, Wellington, New Zealand.

CONTEXT: International guidelines recommend the routine use of oxygen therapy in the treatment of myocardial infarction (MI). OBJECTIVE: To undertake a systematic review and meta-analysis of randomised placebo-controlled trials of oxygen therapy in MI. DATA SOURCES: Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, EMBASE and CINHAL. STUDY SELECTION: Randomised placebo-controlled trials of oxygen therapy in MI. DATA EXTRACTION: The primary clinical outcome was mortality. RESULTS: Two of 51 potential studies met the inclusion criteria. The one study with substantive clinical outcome data reported that in uncomplicated MI, high-flow oxygen was associated with a non-significant increased risk of death (risk ratio 2.9, 95% CI 0.8 to 10.3, p = 0.08) and a greater serum aspartate aminotransferase level (difference 19.2 IU/ml, 95% CI 0 to 38.4, p = 0.05) than room air. CONCLUSION: The limited evidence that does exist suggests that the routine use of high-flow oxygen in uncomplicated MI may result in a greater infarct size and possibly increase the risk of mortality.

PMID: 18708420 [PubMed - indexed for MEDLINE]

Now I wouldn’t change my practice based on this one journal article. You should always follow the protocols and guidelines approved for you by your medical director, but it may give an indication of the direction science may be moving.

I will likely do a larger post on this topic.

A couple years ago I addressed it in this post

http://medicscribe.com/2007/05/oxygen/

Oxygen

Thanks again for the question.

Peter C

By: Darrin B.

Darrin B. — Thu, 19 Nov 2009 02:06:27 +0000

“As far as high flow 02, again per ACLS this is not indicated in a patient who is Satting normally without respiratory distress. There are new studies coming out that show high flow 02 may be detrimental in MIs. I had her on a cannula at 2 lpm.”

I’m just curious as I’ve heard mixed opinions on high flow O2 depending on sat, and I’m by no means questioning you on this as I’m a fairly new EMT and not a medic (although I may go for EMT-I in the somewhat near future). However, could you post some of those links to the studies or guide me in the right direction showing that high flow O2 is actually detrimental. Most of what has been drilled into my head especially in pts with cardiac issues, especially MIs is flood them with oxygen to reduce cardiac irritability due to lack of oxygen. So, I’m just curious to read as to how high flow O2 could actually be detrimental to the pt. Thanks in advance.