ST Elevation Myocardial Infarction Oxygen Therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
Associate Editor: Cafer Zorkun, M.D., Ph.D. [2] Phone:617-525-7431
Oxygen
Mechanism of Benefit
Oxygen is administered to the vast majority of patients with ST elevation myocardial infarction (STEMI). There is limited data to suggest that supplemental oxygen improves ST segment resolution (a surrogate endpoint)[1]
The theoretical basis for oxygen administration is also based on the fact that there may be ventilation perfusion mismatch early in the patient's course[1]
Clinical Trial Data
Large scale randomized clinical trial data is lacking regarding its impact on mortality or other hard clinical endpoints.
Dosing
In general oxygen is administered via nasal canula or face mask to patients with an uncomplicated course to maintain an oxygen saturation greater than 90%. However, endotracheal intubation may be required in those patients with a clinical course complicated by severe pulmonary edema, cardiogenic shock or mechanical complications (e.g. papillary muscle rupture, free wall rupture, or ventricular septal defect).
Side Effects
While the majority of patients may benefit from supplemental oxygen administration, excess oxygen administration may be harmful to those patients with chronic obstructive pulmonary disease. Administration of oxygen to these patients should be judicious and guided by periodic arterial blood gas values.
Guidelines (DO NOT EDIT)
Class I
Supplemental oxygen should be administered to patients with arterial oxygen desaturation (SaO2 less than 90%). (Level of Evidence: B)
Class IIa
It is reasonable to administer supplemental oxygen to all patients with uncomplicated STEMI during the first 6 hours. (Level of Evidence: C)[1]
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
