Oxygen therapy for acute myocardial infarction

Abstract

There is no conclusive evidence from randomised controlled trials to support the routine use of inhaled oxygen in patients with acute AMI. A definitive randomised controlled trial is urgently required given the mismatch between trial evidence suggestive of possible harm from routine oxygen use and recommendations for its use in clinical practice guidelines.

A randomised controlled trial of the effect of high concentration oxygen on myocardial ischaemia during exercise

“…In acute coronary syndromes the inflammatory and thrombotic milieu, the effects of pharmacological therapy or percutaneous intervention, and the presence of reperfusion injury, may result in a different response to oxygen therapy. Indeed, a recent Cochrane meta-analysis of the only two published randomised controlled trials that investigated the mortality risk of oxygen compared with room air in myocardial infarction reported a trend towards increased risk of death with oxygen therapy (OR 3.03, 95% CI 0.98-9.83) [33]. It is crucial that large multicentre randomised controlled trials are undertaken to resolve this clinical uncertainty.…”

2011 addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for the management of acute coronary syndromes (ACS) 2006

“…18 Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events. [52] examining this question identified three trials with a total of 387 patients in whom 14 deaths occurred. The relative risk of death for those receiving oxygen therapy was 2.88 (95% CI 0.88-9.39) by intention-to-treat analysis and 3.03 (95% CI 0.93-9.83) amongst patients with confirmed acute MI.…”

“…Whilst these findings suggest increased hazard, the analyses lacked adequate power to address the risks and benefits of oxygen therapy in acute MI. There is currently insufficient evidence to formulate clear recommendations about oxygen therapy [52]. Definitive trials are needed to answer this question.…”

Rationaler Einsatz von Sauerstoff in Anästhesie und Intensivmedizin

“…Im Jahr 2010 bewertete eine Cochrane-Analyse die Gabe von O 2 im Rahmen des akuten Myokardinfarkts [13]. Interessanterweise konnten lediglich 3 Studien mit dem Zielparameter "Letalität" in diese Analyse eingeschlossen werden [61,77,83].…”