Cochrane Database of Systematic Reviews

Oxygen therapy for acute myocardial infarction (Review)

Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T

Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T.

Oxygen therapy for acute myocardial infarction.
Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD007160.
DOI: 10.1002/14651858.CD007160.pub4.

www.cochranelibrary.com

Oxygen therapy for acute myocardial infarction (Review)

Copyright 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Review]

Oxygen therapy for acute myocardial infarction

Juan B Cabello1 , Amanda Burls2 , Jos I Emparanza3 , Susan E Bayliss4 , Tom Quinn5
1 Department of Cardiology & CASP Spain, Hospital General Universitario de Alicante, Alicante, Spain. 2 School of Health Sciences,

City University London, London, UK. 3 Unidad de Epidemiologa Clnica. CASPe. CIBERESP, Hospital Universitario Donostia, San
Sebastin, Spain. 4 Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK. 5 Faculty of Health,
Social Care and Education, Kingston University and St Georges University of London, London, UK

Contact address: Juan B Cabello, Department of Cardiology & CASP Spain, Hospital General Universitario de Alicante, Pintor Baeza
12, Alicante, Alicante, 03010, Spain. jbcabello@redcaspe.org.

Editorial group: Cochrane Heart Group.

Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 12, 2016.

Citation: Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T. Oxygen therapy for acute myocardial infarction. Cochrane Database
of Systematic Reviews 2016, Issue 12. Art. No.: CD007160. DOI: 10.1002/14651858.CD007160.pub4.

Copyright 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT
Background
Oxygen (O2 ) is widely used in people with acute myocardial infarction (AMI). Previous systematic reviews concluded that there was
insufficient evidence to know whether oxygen reduced, increased or had no effect on heart ischaemia or infarct size. Our first Cochrane
review in 2010 also concluded there was insufficient evidence to know whether oxygen should be used. Since 2010, the lack of evidence
to support this widely used intervention has attracted considerable attention, prompting further trials of oxygen therapy in myocardial
infarction patients. It is thus important to update this Cochrane review.
Objectives
To assess the effects of routine use of inhaled oxygen for acute myocardial infarction (AMI).
Search methods
We searched the following bibliographic databases on 6 June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL) in
the Cochrane Library, MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO) and Web of Science (Thomson Reuters). LILACS
(Latin American and Caribbean Health Sciences Literature) was last searched in September 2016. We also contacted experts to identify
eligible studies. We applied no language restrictions.
Selection criteria
Randomised controlled trials in people with suspected or proven AMI (ST-segment elevation myocardial infarction (STEMI) or non-
STEMI) within 24 hours after onset, in which the intervention was inhaled oxygen (at normal pressure) compared to air, regardless of
co-therapies provided to participants in both arms of the trial.
Data collection and analysis
Two authors independently reviewed the titles and abstracts of identified studies to see if they met the inclusion criteria and independently
undertook the data extraction. We assessed the quality of studies and the risk of bias according to guidance in the Cochrane Handbook
for Systematic Reviews of Interventions. The primary outcome was death. The measure of effect used was the risk ratio (RR) with a 95%
confidence interval (CI). We used the GRADE approach to evaluate the quality of the evidence and the GRADE profiler (GRADEpro)
to import data from Review Manager 5 and create Summary of findings tables.
Oxygen therapy for acute myocardial infarction (Review)
Copyright 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Main results
The updated search yielded one new trial, for a total of five included studies involving 1173 participants, 32 of whom died. The pooled
risk ratio (RR) of all-cause mortality in the intention-to-treat analysis was 0.99 (95% CI 0.50 to 1.95; 4 studies, N = 1123; I2 = 46%;
quality of evidence: very low) and 1.02 (95% CI 0.52 to 1.98; 4 studies, N = 871; I2 = 49%; quality of evidence: very low) when only
analysing participants with confirmed AMI. One trial measured pain directly, and two others measured it by opiate usage. The trial
showed no effect, with a pooled RR of 0.97 for the use of opiates (95% CI 0.78 to 1.20; 2 studies, N = 250). The result on mortality
and pain are inconclusive. There is no clear effect for oxygen on infarct size (the evidence is inconsistent and low quality).
Authors conclusions
There is no evidence from randomised controlled trials to support the routine use of inhaled oxygen in people with AMI, and we cannot
rule out a harmful effect. Given the uncertainty surrounding the effect of oxygen therapy on all-cause mortality and on other outcomes
critical for clinical decision, well-conducted, high quality randomised controlled trials are urgently required to inform guidelines in
order to give definitive recommendations about the routine use of oxygen in AMI.

PLAIN LANGUAGE SUMMARY

Routine use of oxygen in people who have had a heart attack
Background
Many people who are having a heart attack are routinely given oxygen to breathe.
Review question
We looked for the evidence to support this longstanding practice by searching for randomised controlled trials that compared the
outcomes for people given oxygen versus normal air to breathe. We were primarily interested in seeing whether there was a difference
in the number of people who died, but we also looked at whether administering oxygen reduced pain or other adverse outcomes.
Key results
We found five randomised controlled trials that compared people with suspected or proven heart attack who were given oxygen to a
similar group of people who were given air (evidence is current to June 2016). These trials involved a total of 1173 participants, 32 of
whom died. There were similar death rates in both groups, suggesting oxygen neither helps nor harms, but the trials are not big enough
to know for sure. Moreover, it is possible that more heart muscle might be damaged in people given oxygen than in people given air.
Conclusion
Since there is no evidence whether the oxygen is good or harmful in this clinical condition, it is important to test oxygen in a big trial
as soon as possible to be sure that this common treatment is doing more good than harm in people who are having a heart attack.

Oxygen therapy for acute myocardial infarction (Review)

Copyright 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.