Over the past several years there have been an increasing number of studies challenging the time-honored practice of administering oxygen to patients with acute MI regardless of their oxygenation status (see our Patient Safety Tips of the Week April 8, 2008 “Oxygen as a Medication” and January 27, 2009 “Oxygen Therapy: Everything You Wanted to Know and More!” and our What’s New in the Patient Safety World columns for July 2010 “Cochrane Review: Oxygen in MI” and February 2012 “More Evidence of Harm from Oxygen”).
A new pilot randomized controlled trial (Ranchord 2012) found no evidence of benefit or harm from oxygen administration in patients with acute ST-elevation myocardial infarction (STEMI). However, patients were not randomized until they reached the hospital so some had already received oxygen in transit to the hospital. The study results also had wide confidence intervals. So further studies are still needed.
Hopefully answers may be forthcoming in the near future. The AVOID Trial (Stub 2012) is an Australian randomized controlled trial of oxygen therapy beginning in the prehospital phase in patients with acute STEMI who are not hypoxemic. The article details the clinical trial that is about to begin and also notes two other ongoing trials that may provide answers.
In the interim, think twice before you begin oxygen on the non-hypoxemic patient.
Ranchord AM, Argyle R, Beynon R, Perrin K, et al. High-concentration versus titrated oxygen therapy in ST-elevation myocardial infarction: A pilot randomized controlled trial. Am Heart J 2012; 163(2): 168-175
Stub D, Smith K, Bernard S, et al. A randomized controlled trial of oxygen therapy in acute myocardial infarction Air Verses Oxygen In myocarDial infarction study (AVOID Study). Am Heart J 2012; 163: 339-345