• DETermination of the role of OXygen in suspected Acute Myocardial Infarction trial – DETO2X-AMI

    by Alan Batt. Last modified: 02/03/14

    spo2

    This will be an interesting trial to see the results of and it should help guide the practice of supplemental oxygen delivery to normoxemic patients suffering from acute myocrdial infarction. High flow supplemental oxygen to anyone who is ill or injured is another intervention that is widely carried out by prehospital providers worldwide that is based on dogma rather than scientific evidence.

    Website: http://deto2x.se/english/

    Summary

    • Randomised controlled trial which will enroll 6,600 patients
    • Patients will be normoxemic on admission to trial (oxygen saturation [SpO2] ≥90%)
    • Patients will be randomised to either
      • Room air for 6-12 hours
      • Oxygen via mask at 6 litres per minute for 6-12 hours
    • Primary objective is to evaluate whether oxygen reduces 1-year all-cause mortality
    • Secondary end points include
      • 30-day mortality
      • Major adverse cardiac events
      • Health economy
     
    Hofmann R1, James SK2, Svensson L3, Witt N3, Frick M3, Lindahl B2, Ostlund O2, Ekelund U4, Erlinge D5, Herlitz J6, Jernberg T7. DETermination of the role of OXygen in suspected Acute Myocardial Infarction trial. Am Heart J. 2014 Mar;167(3):322-8. PMID: 24576515.

    Abstract

    Background

    The use of supplemental oxygen in the setting of suspected acute myocardial infarction (AMI) is recommended in international treatment guidelines and established in prehospital and hospital clinical routine throughout the world. However, to date there is no conclusive evidence from adequately designed and powered trials supporting this practice. Existing data are conflicting and fail to clarify the role of supplemental oxygen in AMI.

    Methods

    A total of 6,600 normoxemic (oxygen saturation [SpO2] ≥90%) patients with suspected AMI will be randomly assigned to either supplemental oxygen 6 L/min delivered by Oxymask (MedCore Sweden AB, Kista, Sweden) for 6 to 12 hours in the treatment group or room air in the control group. Patient inclusion and randomization will take place at first medical contact, either before hospital admission or at the emergency department. The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry will be used for online randomization, allowing inclusion of a broad population of all-comers. Follow-up will be carried out in nationwide health registries and Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies. The primary objective is to evaluate whether oxygen reduces 1-year all-cause mortality. Secondary end points include 30-day mortality, major adverse cardiac events, and health economy. Prespecified subgroups include patients with confirmed AMI and certain risk groups. In a 3-month pilot study, the study concept was found to be safe and feasible.

    Conclusion

    The need to clarify the uncertainty of the role of supplemental oxygen therapy in the setting of suspected AMI is urgent. The DETO2X-AMI trial is designed and powered to address this important issue and may have a direct impact on future recommendations.

    References

     
    1.

    Hofmann R1, James SK2, Svensson L3, Witt N3, Frick M3, Lindahl B2, Ostlund O2, Ekelund U4, Erlinge D5, Herlitz J6, Jernberg T7. DETermination of the role of OXygen in suspected Acute Myocardial Infarction trial. Am Heart J. 2014 Mar;167(3):322-8. PMID: 24576515.

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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