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Oxygen in acute uncomplicated myocardial infarction
  1. Richard Body, Senior House Officer,
  2. Kerstin Hogg, Clinical Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether supplemental oxygen reduces mortality in patients with uncomplicated acute myocardial infarction. Altogether 290 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

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    Report by Richard Body, Senior House OfficerChecked by Kerstin Hogg, Clinical Research Fellow

    Clinical scenario

    A 60 year old man presents to the emergency department with acute severe crushing chest pain. ECG shows changes consistent with acute myocardial infarction. You prescribe aspirin, thrombolysis, nitroglycerin, β blockers, and high flow oxygen. You know that oxygen therapy is traditionally held to be beneficial in this situation, but wonder if there is any evidence that it reduces mortality.

    Three part question

    In [patients with acute uncomplicated myocardial infarction] does [oxygen therapy] lead to [reduced mortality]?

    Search strategy

    Medline 1966-10/03 using the OVID interface. [exp myocardial infarction OR myocardial infarct$.mp OR MI.mp OR heart attack.mp OR exp Coronary Thrombosis OR acute coronary syndrome.mp] AND [exp oxygen OR oxygen.mp OR O2.mp OR exp oxygen inhalation therapy] AND [exp Mortality OR exp Hospital Mortality OR mortality.mp OR exp Death OR death.mp] LIMIT to human AND English.

    Search outcome

    Altogether 290 papers were identified, only one of which was relevant to the question (table 1).

    Table 1

    Comment(s)

    The routine use of oxygen in myocardial infarction has been widely advocated for many years. However, the only study to investigate the efficacy of this approach was underpowered to show a difference in mortality.

    CLINICAL BOTTOM LINE

    In patients with uncomplicated acute myocardial infarction there is no evidence that supplemental oxygen reduces mortality. However the there is no evidence of harm. Further research is required before changes in current practice should be recommended.

    Report by Richard Body, Senior House OfficerChecked by Kerstin Hogg, Clinical Research Fellow

    References

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