Supplemental Oxygen Is Not Needed for STEMI Patients with Normal Oxygen Saturations

June 19, 2015

Supplemental Oxygen Is Not Needed for STEMI Patients with Normal Oxygen Saturations

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Outcomes were either similar or worse for STEMI patients given supplemental oxygen, compared with those who maintained a saturation ≥94% on their own.

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Supplemental oxygen likely provides no benefit to — and may even harm — patients with chronic obstructive pulmonary disease or other causes of dyspnea (NEJM JW Emerg Med Nov 2010 and BMJ 2010; 341:c5462 and Physician's First Watch Sep 3 2010 and Lancet 2010; 376:784). However, it is used ubiquitously in patients with ST-segment elevation myocardial infarction (STEMI) due to the ischemic nature of the disease. To date, several small studies have suggested that oxygen may not have any benefit in STEMI. To determine its effects, investigators in Australia conducted a randomized trial of supplemental oxygen versus room air in patients with out-of-hospital STEMI.

Oxygen (8 L/minute) and air were administered by paramedics and continued through the cath lab and into inpatient units. Patients in the control group did not receive oxygen unless their saturations dropped below 94%. Of 638 patients randomized by paramedics, 441 had confirmed STEMI on angiography and were included in the intention-to-treat analysis. The primary outcome was myocardial injury (as defined by troponin and creatine kinase levels).

Mean peak troponin levels were not statistically different in the two groups. However, the oxygen group had significantly higher mean peak creatine kinase values (1948 vs. 1543 U/L), higher rate of recurrent MI during hospitalization (5.5% vs. 0.9%) and greater increases in infarct size at 6 months on magnetic resonance imaging (20.3 vs. 13.1 grams).

Comment

At best, supplemental oxygen is not needed for patients with STEMI who are able to maintain normal saturations. At worst, it may be harmful. Either way, this current mainstay treatment should be removed from the routine management of these patients.

Editor Disclosures at Time of Publication

  • Disclosures for Ali S. Raja, MD, MBA, MPH, FACEP at time of publication Speaker's bureau Airway Management Education Center Leadership positions in professional societies Society for Academic Emergency Medicine (Constitution and Bylaws Committee Chair, Program Committee Chair, and Trauma Interest Group Chair); American College of Emergency Physicians (Trauma and Injury Prevention Section Chair)

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.