In the past, high flow oxygen was routinely administered to patients with suspected acute myocardial infarction. Recent evidence has suggested there is no benefit from hyperoxaemia, and in these patients it might result in adverse outcomes. The Australian and New Zealand Council of Resuscitation (ANZCOR) guideline previously recommended routine oxygen therapy, but a recent change has occurred. The ANZCOR current guideline recommends selective use of oxygen therapy in patients with suspected acute myocardial infarction, to achieve oxygen saturations ≥94% and <98%. Because the change occurred recently, the South Australian paramedic adherence rate to the ANZCOR guideline was unknown. Therefore, the aim of this study was to determine the South Australian paramedic adherence rate to the ANZCOR oxygen use in acute coronary syndrome recommendations.
A retrospective audit of patient case notes was conducted, for patients with chest pain presenting via ambulance to a tertiary hospital emergency department, during a 3-month period. Paramedic administration of oxygen therapy was then compared against the ANZCOR recommendations.
Paramedics treated a total of 111/139 (79.9%, CI 72.4–85.7%) in line with the ANZCOR guideline and the treatment of 28/139 (20.1%, CI 14.3–27.6%) fell outside of the recommendations.
Although the results demonstrated a degree of compliance, this could be improved through clinical education, a review of the local chest pain guidelines, an introduction of a drug protocol for oxygen therapy and future research investigating the reasons for non-compliance to the best practice guidelines.
South Australian Ambulance Service. Ischaemic chest pain guideline CPG013 2016. [Accessed 5 September 2017].
Carhart E, Salzman JG. Prehospital oxygen administration for chest pain patients decreases significantly following implementation of the 2010 AHA Guidelines. Prehosp Emerg Care 2014;18:471-5.
Australian and New Zealand Committee on Resuscitation. Guideline 14.2 –Acute coronary syndrome: initial medical therapy 2016. Available at: http://resus.org.au/guidelines/ [Accessed 9 May 2016].
Stub D, Smith K, Bernard S, et al. Air versus oxygen in ST-segment elevation myocardial infarction. Circulation 2015;131:2143-50.
National Institute for Health and Care Excellence. Types of guidelines. Available at: www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/types-of-guideline
Sox HC, Stewart WF. Algorithms, clinical practice guidelines, and standardized clinical assessment and management plans: evidence-based patient management standards in evolution. Acad Med 2015;90:129-32.
National Health and Medical Research Council. How guidelines are developed. Available at: https://nhmrc.gov.au/health-advice/how-guidelines-are-developed [Accessed 14 June 2017].
World Health Organization. WHO Handbook for guideline development 2012. Available at: http://apps.who.int/iris/bitstream/10665/75146/1/9789241548441_eng.pdf [Accessed 17 June 2017].
Meier P, Ebrahim S, Otto C, Casas JP. Oxygen therapy in acute myocardial infarction - good or bad? Cochrane Database Syst Rev 2013(8):Ed000065.
Maroko PR, Radvany P, Braunwald E, Hale SL. Reduction of infarct size by oxygen inhalation following acute coronary occlusion. Circulation 1975;52:360-8.
Hofmann R, James SK, Jernberg T, et al. Oxygen therapy in suspected acute myocardial infarction. N Engl J Med 2017;377:1240-9.
Sepehrvand N, James SK, Stub D, et al. Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials. Heart 2018;104:1691-8.
International Liason Committee on Resuscitation. Part 9: Acute coronary syndromes 2015. Available at: https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-9-acute-coronary-syndromes/ [Accessed 5 December 2017].
South Australian Ambulance Service. Who we are. Available at: www.saambulance.com.au/Whoweare.aspx [Accessed 29 December 2017].
Australian Bureau of Statistics. South Australia STE 2015. Available at: http://stat.abs.gov.au/itt/r.jsp?RegionSummary®ion=4&dataset=ABS_REGIONAL_ASGS&geoconcept=REGION&datasetASGS=ABS_REGIONAL_ASGS&datasetLGA=ABS_NRP9_LGA®ionLGA=REGION®ionASGS=REGION [Accessed 2 January 2018].
Cretikos MA, Bellomo R, Hillman K, Chen J, Finfer S, Flabouris A. Respiratory rate: the neglected vital sign. Med J Aust 2008;188:657.
Marik PE, Lipman J. The definition of septic shock: implications for treatment. Crit Care Resusc 2007;9:101.
Nehme Z, Stub D, Bernard S, et al. Effect of supplemental oxygen exposure on myocardial injury in ST-elevation myocardial infarction. Heart 2016;102:444-51.