Difference between revisions of "Swift"

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'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Hyperbaric oxygen administration improved ventricular wall motion in patients following acute myocardial infarction.</span>'''
 
  
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<span style="border-color: windowtext; border-style: solid; border-width: 1.5pt; display: block; padding: 1pt 4pt;">
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<span style="font-size:x-large;">'''<span style="font-family:">Hyperbaric oxygen administration improved ventricular wall motion in patients following acute myocardial infarction.</span>'''</span>
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<span style="padding-bottom: 0cm; padding-left: 0cm; padding-right: 0cm; padding-top: 0cm;">'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Clinical Bottom Line:</span>'''
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">1. The administration of hyperbaric oxygen was associated with significant improvement of ventricular wall motion compared to those patients on air.</span></span>
 
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</span>
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Appraised by:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Sydney; Thursday, 3 June 1999</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Clinical Scenario:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> A patient with acute myocardial infarction. </span>
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<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>
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Three-part Question:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> 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? </span>
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Search Terms:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> Myocardial infarction</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">The Study:</span>'''
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<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>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Double-blinded concealed randomised controlled trial with intention-to-treat.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Patients with a firm diagnosis of myocardial infarction within one week and abnormal wall motion on transoesophageal echo, who were otherwise stable.</span>
 
−
<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">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>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Experimental group (N = 24; 24 analysed): As above, but compression breathing 2ATA of 100% oxygen.</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">The Evidence:</span>'''
+
----
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{|
+
 
−
| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;;">Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;;">Time to Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;;">Air group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;;">HBO group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;;">Relative risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;;">Absolute risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;;">NNT</span>'''</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>
 +
 
 +
<span style="font-size:medium;"><span style="font-family:">'''Three-part Question:&nbsp;'''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?</span></span>
 +
 
 +
<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>
 +
 
 +
<span style="font-size:medium;"><span style="font-family:">'''Experimental group''' (N = 24; 24 analysed): As above, but compression breathing 2ATA of 100% oxygen.</span></span>
 +
 
 +
'''<span style="font-size:medium;">​​​​​​​<span style="font-family:">The Evidence:</span></span>'''
 +
 
 +
&nbsp;
 +
 
 +
{| class="Table" style="border:solid windowtext 1.0pt"
 
|-
 
|-
−
| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;;">Ventricular contraction not improved</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; text-align: center;">1 hour</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; text-align: center;">1.0</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; text-align: center;">0.5</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; text-align: center;">INF</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; text-align: center;">0.5</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; text-align: center;">2</span></span>  
+
| style="border:solid windowtext 1.0pt" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Outcome</span></span>'''</span>
 +
 
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Time to Outcome</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Air group</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">HBO group</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Relative risk reduction</span></span>'''</span></p>
 +
| style="border: 1pt solid windowtext; width: 126px;" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Absolute risk reduction</span></span>'''</span></p>
 +
| style="border: 1pt solid windowtext; width: 61px;" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">NNT</span></span>'''</span></p>  
 
|-
 
|-
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,&#39;serif&#39;;">95% CI:</span>'''</span></span> ||  ||  ||  ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; text-align: center;">0.30 to 0.70</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; text-align: center;">1 to 3</span></span>  
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| style="border:solid windowtext 1.0pt" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Ventricular contraction not improved</span></span>'''</span>
 +
 
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1 hour</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1.0</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.5</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">INF</span></span></span></p>
 +
| style="border: 1pt solid windowtext; width: 126px;" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.5</span></span></span></p>
 +
| style="border: 1pt solid windowtext; width: 61px;" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">2</span></span></span></p>  
 
|-
 
|-
 +
| style="border:solid windowtext 1.0pt" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">95% CI:</span></span>'''</span>
 +
 +
| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | &nbsp;
 +
| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | &nbsp;
 +
| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | &nbsp;
 +
| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | &nbsp;
 +
| style="border: 1pt solid windowtext; width: 126px;" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.30 to 0.70</span></span></span></p>
 +
| style="border: 1pt solid windowtext; width: 61px;" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1 to 3</span></span></span></p>
 
|}
 
|}
  
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{|  
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&nbsp;
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| <span style'''"line-height: normal; margin-bottom: 0pt;">'''Non-event outcomes'''</span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">'''Time to outcome'''</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">'''Air group'''</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">'''HBO group'''</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style="display: block; text-align: center;">'''P-value'''</span></span>
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 +
{| class="Table" style="border:solid windowtext 1.0pt"
 
|-
 
|-
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| <span style'''"line-height: normal; margin-bottom: 0pt;">'''Mean arterial blood pressure change (mmHg)'''</span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">1 hour</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">-3</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">-3</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style="display: block; text-align: center;">NS</span></span>  
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| style="border:solid windowtext 1.0pt" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Non-event outcomes</span></span>'''</span>
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 +
| style="border:solid windowtext 1.0pt" |  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Time to outcome</span></span>'''</span>
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| style="border:solid windowtext 1.0pt" |  
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Air group</span></span>'''</span>
 +
 
 +
| style="border:solid windowtext 1.0pt" |  
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">HBO group</span></span>'''</span>
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| style="border:solid windowtext 1.0pt" |  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">P-value</span></span>'''</span>
 +
 
 
|-
 
|-
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| <span style'''"line-height: normal; margin-bottom: 0pt;">'''Mean heart rate change (bpm)'''</span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">1 hour</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">0</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">-5</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style="display: block; text-align: center;">NS</span></span>  
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| style="border:solid windowtext 1.0pt" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Mean arterial blood pressure change (mmHg)</span></span>'''</span>
 +
 
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1 hour</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-3</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-3</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">NS</span></span></span></p>  
 
|-
 
|-
 +
| style="border:solid windowtext 1.0pt" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Mean heart rate change (bpm)</span></span>'''</span>
 +
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1 hour</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-5</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p style="margin-bottom: 0.0001pt; padding: 0.75pt; text-align: center;"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">NS</span></span></span></p>
 
|}
 
|}
−
**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Comments:</span>'''
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">1. Randomised on a 2 active to 1 control regimen.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">2. Identification of hibernating myocardium may have important implications for future management, but this is unclear at this stage.</span>
 
−
<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">3. Much of this paper is taken with the comparison of methods of detecting hibernating myocardium and not directly with the randomised trial.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">4. Steady heart rate and BP indicate no large effect of compression itself or of hyperoxia on haemodynamic parameters.</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">Expiry date:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;"> June 2021</span>
+
&nbsp;
−
**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">References: </span>'''
+
 
−
<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 15px;">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 style="font-size:medium;"><span style="font-family:">Comments:</span></span>'''
−
<span style="display: block; text-align: center;">
+
 
 +
<span style="font-size:medium;"><span style="font-family:">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:">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:">Expiry date:</span>&nbsp;'''<span style="font-family:">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>
 +
 
 +
​​​​​​​
  
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[[File:sumhorsa.gif|center]]
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[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
  
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Acute ischaemia | BACK]]'''</span>
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Myocardial_ischaemia|BACK]]'''</span>
  
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</span>
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&nbsp;

Latest revision as of 03:50, 22 August 2022

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.

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.

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

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

​​​​​​​

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