Stavitsky - Revision history

M.bennett at 07:57, 22 August 2022

2022-08-22T07:57:26Z

M.bennett at 01:47, 16 September 2021

2021-09-16T01:47:52Z

M.bennett at 07:33, 8 September 2021

2021-09-08T07:33:22Z

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M.bennett at 07:33, 8 September 2021

2021-09-08T07:33:05Z

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M.bennett at 07:20, 8 September 2021

2021-09-08T07:20:08Z

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Gordoben: Imported from Wikispaces

2018-06-04T07:13:37Z

Imported from Wikispaces

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'''Hyperbaric oxygen reduced time to pain relief in patients following acute myocardial infarction.'''


'''Clinical Bottom Line:'''
1. The time to pain relief following myocardial infarction was reduced following the addition of hyperbaric oxygen to the treatment protocol.
2. There was no significant improvement in other measures of outcome, although there was a trend to lower CPK levels, LVEF and mortality. 

**Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Friday, 4 June 1999

**Clinical Scenario:''' A patient with acute myocardial infarction. 
**Three-part Question: '''In patients with acute myocardial infarction, does the early administration of hyperbaric oxygen, in addition to a standard care protocol including thrombolysis, result in any demonstrable improvement in outcome? 
**Search Terms:''' myocardial infarction, thrombolysis

**The Study:'''
Non-blinded randomised controlled trial without intention-to-treat.
Patients with AMI diagnosed by ECG changes and clinical features and who were eligible for thrombolysis.
Control group (N = 69;63 analysed (41 all data)): Standard care including thrombolytics and aspirin. No sham treatment.
Experimental group (N = 69;59 analysed (40 all data)): As above, but immediately following diagnosis, patients were given hyperbaric oxygen at 2ATA on 100% for a total chamber time of 2 hours. 

**The Evidence:'''
{|
| '''Outcome''' || '''Time to Outcome''' || '''Control group''' || '''HBO group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT'''
|-
| '''Death''' || Discharge || 0.032 || 0.017 || 47% || 0.015 || 67
|-
| '''95%CI:''' || || || || -100% to 100% || -0.04 to 0.07 || NNT'''14 to INF NNH=25 to INF
|-
| '''Non-event outcomes''' || '''Time to outcome''' || '''Control group''' || '''HBO group''' || '''P-value'''
|-
| '''Time to pain relief''' || Variable || 614 || 261 || <0.001
|-
| '''CPK (activity)''' || 12 hours || 1,828 || 1,690 || >0.05
|-
|}
**Comments:'''
1. Multicentre study with considerable loss of data, no intention to treat analysis and no blinding. There is some danger of bias.
2. All outcomes except time to pain relief show a non-significant trend in favour of the HBO group. A larger study may confirm a treatment effect.

**Expiry date:''' June 2021
**References: '''
Stavitsky Y, Shandling AH, Ellestad MH, Hart GB, Van Natta B, Messenger JC, Strauss M, Dekleva MN, Alexander JM, Mattice M, Clarke D. Hyperbaric oxygen and thrombolysis in myocardial infarction: the 'HOT MI' randomised multicenter study. Cardiology 1998; 90:131-136.



[[File:sumhorsa.gif|center]]

'''[[Acute ischaemia | BACK]]'''

@@ Line 14: / Line 14: @@
 <span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Citation:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">1. Stavitsky Y, Shandling AH, Ellestad MH, Hart GB, Van Natta B, Messenger JC, Strauss M, Dekleva MN, Alexander JM, Mattice M, Clarke D. Hyperbaric oxygen and thrombolysis in myocardial infarction: the 'HOT MI' randomised multicenter study. Cardiology 1998; 90:131-136.</span></span></span></span></span>
 <span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Clinical Scenario:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">A patient with acute myocardial infarction.</span></span></span></span></span>
@@ Line 68: / Line 70: @@
 | style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 105px;" | <p style="margin-bottom: 0.0001pt; padding: 0cm; text-align: center;"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:"><span style="color:#001133">HBO group</span></span></span>'''</span></p>
 | style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 119px;" | <p style="margin-bottom: 0.0001pt; padding: 0cm; text-align: center;"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:"><span style="color:#001133">P-value</span></span></span>'''</span></p>
 |-
 | style="border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; border-image: initial; border-top: none; background: white; width: 106px;" |
@@ Line 78: / Line 78: @@
 | style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 105px;" | <p style="margin-bottom: 0.0001pt; padding: 0cm; text-align: center;"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:"><span style="color:#001133">261</span></span></span></span></p>
 | style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 119px;" | <p style="margin-bottom: 0.0001pt; padding: 0cm; text-align: center;"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:"><span style="color:#001133"><0.001</span></span></span></span></p>
 |-
 | style="border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; border-image: initial; border-top: none; background: white; width: 106px;" |
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 | style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 105px;" | <p style="margin-bottom: 0.0001pt; padding: 0cm; text-align: center;"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:"><span style="color:#001133">1,690</span></span></span></span></p>
 | style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 119px;" | <p style="margin-bottom: 0.0001pt; padding: 0cm; text-align: center;"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:"><span style="color:#001133">>0.05</span></span></span></span></p>
 |}

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−	<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[~~Acute_ischaemia~~\|BACK]]'''</span>	+	<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Myocardial_ischaemia\|BACK]]'''</span>