Swift - Revision history

M.bennett at 07:50, 22 August 2022

2022-08-22T07:50:59Z

M.bennett at 05:50, 23 August 2021

2021-08-23T05:50:17Z

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M.bennett at 05:48, 23 August 2021

2021-08-23T05:48:06Z

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Gordoben: Imported from Wikispaces

2018-06-04T07:12:01Z

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'''Hyperbaric oxygen administration improved ventricular wall motion in patients following acute myocardial infarction.'''


'''Clinical Bottom Line:'''
1. The administration of hyperbaric oxygen was associated with significant improvement of ventricular wall motion compared to those patients on air.

**Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Thursday, 3 June 1999

**Clinical Scenario:''' A patient with acute myocardial infarction. 
**Three-part Question:''' In patients with hibernating myocardium following a myocardial infarction, does the administration of hyperbaric oxygen as compared to air result in improved ventricular wall contractility? 
**Search Terms:''' Myocardial infarction

**The Study:'''
Double-blinded concealed randomised controlled trial with intention-to-treat.
Patients with a firm diagnosis of myocardial infarction within one week and abnormal wall motion on transoesophageal echo, who were otherwise stable.
Control group (N = 10; 10 analysed): Following transoesophageal and transthoracic echocardiography, compression to 2ATA breathing air for 30 minutes, 10 minutes decompression and repeat echocardiography.
Experimental group (N = 24; 24 analysed): As above, but compression breathing 2ATA of 100% oxygen.

**The Evidence:'''
{|
| '''Outcome''' || '''Time to Outcome''' || '''Air group''' || '''HBO group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT'''
|-
| '''Ventricular contraction not improved''' || 1 hour || 1.0 || 0.5 || INF || 0.5 || 2
|-
| '''95% CI:''' || || || || || 0.30 to 0.70 || 1 to 3
|-
|}

{|
| '''Non-event outcomes''' || '''Time to outcome''' || '''Air group''' || '''HBO group''' || '''P-value'''
|-
| '''Mean arterial blood pressure change (mmHg)''' || 1 hour || -3 || -3 || NS
|-
| '''Mean heart rate change (bpm)''' || 1 hour || 0 || -5 || NS
|-
|}
**Comments:'''
1. Randomised on a 2 active to 1 control regimen.
2. Identification of hibernating myocardium may have important implications for future management, but this is unclear at this stage.
3. Much of this paper is taken with the comparison of methods of detecting hibernating myocardium and not directly with the randomised trial.
4. Steady heart rate and BP indicate no large effect of compression itself or of hyperoxia on haemodynamic parameters.

**Expiry date:''' June 2021
**References: '''
1. Swift PC, Turner JH, Oxer HF, O'Sea JP, Lane GK, Woollard KV. Myocardial hibernation identified by hyperbaric oxygen treatment and echocardiography in postinfarction patients: comparison with exercise thallium scintigraphy. American Heart Journal 1992; 124:1151-1158.


[[File:sumhorsa.gif|center]]

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

@@ Line 4: / Line 4: @@
 <span style="border-color: windowtext; border-style: solid; border-width: 1.5pt; display: block; padding: 1pt 4pt;"><span style="font-size:large;"><span style="padding-bottom: 0cm; padding-left: 0cm; padding-right: 0cm; padding-top: 0cm;">'''<span style="font-family:">Clinical Bottom Line:</span>''' <span style="font-family:">1. The administration of hyperbaric oxygen was associated with significant improvement of ventricular wall motion compared to those patients on air.</span></span></span></span>
-<span style="font-size:medium;">'''<span style="font-family:">Appraised by:&nbsp;</span>'''<span style="font-family:">Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital,&nbsp;</span></span><span style="font-size:medium;"><span style="font-family:">Sydney; Thursday, 3 June 1999</span></span>
+<span style="font-size:medium;">'''<span style="font-family:">References:&nbsp;</span>'''<span style="font-family:">1. Swift PC, Turner JH, Oxer HF, O'Sea JP, Lane GK, Woollard KV. Myocardial hibernation identified by hyperbaric oxygen treatment and echocardiography in postinfarction patients: comparison with exercise thallium scintigraphy. American Heart Journal 1992; 124:1151-1158.</span></span>
 <span style="font-size:medium;">'''<span style="font-family:">Clinical Scenario:&nbsp;</span>'''<span style="font-family:">A patient with acute myocardial infarction.</span></span>
@@ Line 12: / Line 14: @@
 <span style="font-size:medium;">'''<span style="font-family:">Search Terms:&nbsp;</span>'''<span style="font-family:">Myocardial infarction</span></span>
 '''<span style="font-size:medium;"><span style="font-family:">The Study:&nbsp;</span></span>'''<span style="font-size:medium;"><span style="font-family:">Double-blinded concealed randomised controlled trial with intention-to-treat.</span> <span style="font-family:">Patients with a firm diagnosis of myocardial infarction within one week and abnormal wall motion on transoesophageal echo, who were otherwise stable.</span></span>
 <span style="font-size:medium;"><span style="font-family:">'''Control group''' (N = 10; 10 analysed): Following transoesophageal and transthoracic echocardiography, compression to 2ATA breathing air for 30 minutes, 10 minutes decompression and repeat echocardiography.</span></span>
@@ Line 94: / Line 96: @@
 &nbsp;
-'''<span style="font-size:medium;"><span style="font-family: " times="" new="" roman",="" serif;"="">Comments:</span></span>'''
+'''<span style="font-size:medium;"><span style="font-family:">Comments:</span></span>'''
-<span style="font-size:medium;"><span style="font-family: " times="" new="" roman",="" serif;"="">1. Randomised on a 2 active to 1 control regimen.</span></span>
+<span style="font-size:medium;"><span style="font-family:">2. Identification of hibernating myocardium may have important implications for future management, but this is unclear at this stage.</span></span>
-<span style="font-size:medium;"><span style="font-family: " times="" new="" roman",="" serif;"="">2. Identification of hibernating myocardium may have important implications for future management, but this is unclear at this stage.</span></span>
+<span style="font-size:medium;"><span style="font-family:">3. Much of this paper is taken with the comparison of methods of detecting hibernating myocardium and not directly with the randomised trial.</span></span>
-<span style="font-size:medium;"><span style="font-family: " times="" new="" roman",="" serif;"="">3. Much of this paper is taken with the comparison of methods of detecting hibernating myocardium and not directly with the randomised trial.</span></span>
+<span style="font-size:medium;"><span style="font-family:">4. Steady heart rate and BP indicate no large effect of compression itself or of hyperoxia on haemodynamic parameters.</span></span>
-<span style="font-size:medium;"><span style="font-family: " times="" new="" roman",="" serif;"="">4. Steady heart rate and BP indicate no large effect of compression itself or of hyperoxia on haemodynamic parameters.</span></span>
+<span style="font-size:medium;">'''<span style="font-family:">Expiry date:</span>&nbsp;'''<span style="font-family:">June 2021</span></span>
-<span style="font-size:medium;">'''<span style="font-family: " times="" new="" roman",="" serif;"="">Expiry date:</span>&nbsp;'''<span style="font-family: " times="" new="" roman",="" serif;"="">June 2021</span></span>
+<span style="font-size:medium;">'''<span style="font-family:">Appraised by:&nbsp;</span>'''<span style="font-family:">Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital,&nbsp;</span></span><span style="font-size:medium;"><span style="font-family:">Sydney; Thursday, 3 June 1999</span></span>
-<span style="font-size:medium;">'''<span style="font-family: " times="" new="" roman",="" serif;"="">References:&nbsp;</span>'''<span style="font-family: " times="" new="" roman",="" serif;"="">1. Swift PC, Turner JH, Oxer HF, O'Sea JP, Lane GK, Woollard KV. Myocardial hibernation identified by hyperbaric oxygen treatment and echocardiography in postinfarction patients: comparison with exercise thallium scintigraphy. American Heart Journal 1992; 124:1151-1158.</span></span>
 [[File:Sumhorsa.gif|center|Sumhorsa.gif]]