Difference between revisions of "Stavitsky"

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'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Hyperbaric oxygen reduced time to pain relief 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="background:white"><span style="line-height:normal">'''<span style="font-size:24.0pt"><span style="font-family:"><span style="color:#001133">Hyperbaric oxygen reduced time to pain relief in patients following acute myocardial infarction.</span></span></span>'''</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 time to pain relief following myocardial infarction was reduced following the addition of hyperbaric oxygen to the treatment protocol.
 
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2. There was no significant improvement in other measures of outcome, although there was a trend to lower CPK levels, LVEF and mortality. </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; Friday, 4 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="background:white"><span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:"><span style="color:#001133">Clinical Bottom Line:</span></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 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? </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, thrombolysis</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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{| class="MsoTableGrid" style="border-collapse: collapse; border: 1pt solid windowtext; width: 865px;"
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Non-blinded randomised controlled trial without intention-to-treat.</span>
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|- style="height:103.4pt"
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Patients with AMI diagnosed by ECG changes and clinical features and who were eligible for thrombolysis.</span>
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| style="width: 859px; border: 1pt solid windowtext;" width="601" |
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Control group (N = 69;63 analysed (41 all data)): Standard care including thrombolytics and aspirin. No sham treatment.</span>
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<span style="background:white"><span style="line-height:normal"><span style="height:103.4pt"><span style="font-size:14.0pt"><span style="font-family:"><span style="color:#001133">1. The time to pain relief following myocardial infarction was reduced following the addition of hyperbaric oxygen to the treatment protocol</span></span></span></span></span></span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">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. </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="background:white"><span style="line-height:normal"><span style="height:103.4pt"><span style="font-size:14.0pt"><span style="font-family:"><span style="color:#001133">2. There was no significant improvement in other measures of outcome, although there was a trend to lower CPK levels, LVEF and mortality.</span></span></span></span></span></span>
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{|  
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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;;">Control 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>  
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|}
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<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>
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----
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<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>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Three-part Question:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">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?</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Search Terms:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">myocardial infarction, thrombolysis</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">The Study:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Non-blinded randomised controlled trial without intention-to-treat.</span></span></span> <span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Patients with AMI diagnosed by ECG changes and clinical features and who were eligible for thrombolysis.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Control group</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">(N = 69;63 analysed (41 all data)): Standard care including thrombolytics and aspirin. No sham treatment.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Experimental group</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">(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.</span></span></span></span></span>
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&nbsp;
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">The Evidence:</span></span></span>'''</span></span>
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{| class="Table" style="background:white; border-collapse:collapse; border:solid windowtext 1.0pt"
 
|-
 
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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;;">Death</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;">Discharge</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;">0.032</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;">0.017</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;">47%</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;">0.015</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;">67</span></span>  
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| style="border: 1pt solid windowtext; background: white; width: 106px;" | <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">Outcome</span></span></span>'''</span></p>  
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| style="border-top: 1pt solid windowtext; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-image: initial; border-left: none; background: white; width: 109px;" | <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">Time to Outcome</span></span></span>'''</span></p>
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| style="border-top: 1pt solid windowtext; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-image: initial; border-left: none; background: white; width: 79px;" | <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">Control group</span></span></span>'''</span></p>
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| style="border-top: 1pt solid windowtext; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-image: initial; border-left: none; 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>
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| style="border-top: 1pt solid windowtext; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-image: initial; border-left: none; 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">Relative risk reduction</span></span></span>'''</span></p>
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| style="border-top: 1pt solid windowtext; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-image: initial; border-left: none; background: white; width: 127px;" | <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">Absolute risk reduction</span></span></span>'''</span></p>
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| style="border-top: 1pt solid windowtext; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-image: initial; border-left: none; background: white; width: 206px;" | <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">NNT</span></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;">-100% to 100%</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;">-0.04 to 0.07</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;">NNT'''14 to INF NNH=25 to INF</span></span>  
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| 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;" | <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">Death</span></span></span>'''</span></p>  
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 109px;" | <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">Discharge</span></span></span></span></p>
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 79px;" | <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">0.032</span></span></span></span></p>
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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">0.017</span></span></span></span></p>
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| 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">47%</span></span></span></span></p>
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 127px;" | <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">0.015</span></span></span></span></p>
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 206px;" | <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">67</span></span></span></span></p>  
 
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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;">'''Control 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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| 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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&nbsp;
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 109px;" | <p style="margin-bottom: 0.0001pt; padding: 0cm; text-align: right;">95%CI</p>  
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 79px;" |  
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&nbsp;
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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;" |
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&nbsp;
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| 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">-100% to 100%</span></span></span></span></p>
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 127px;" | <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">-0.04 to 0.07</span></span></span></span></p>
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 206px;" | <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">NNT14 to INF</span></span></span></span></p> <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">NNH=25 to INF</span></span></span></span></p>  
 
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| <span style'''"line-height: normal; margin-bottom: 0pt;">'''Time to pain relief'''</span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">Variable</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">614</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">261</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style="display: block; text-align: center;"><0.001</span></span>  
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| 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;" | <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">Non-event outcomes</span></span></span>'''</span></p>
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 109px;" | <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">Time to outcome</span></span></span>'''</span></p>
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 79px;" | <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">Control group</span></span></span>'''</span></p>
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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">HBO group</span></span></span>'''</span></p>
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| 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>  
 
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| <span style'''"line-height: normal; margin-bottom: 0pt;">'''CPK (activity)'''</span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">12 hours</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">1,828</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">1,690</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style="display: block; text-align: center;">>0.05</span></span>  
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| 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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<span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:"><span style="color:#001133">Time to pain relief</span></span></span>'''</span>
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 109px;" | <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">Variable</span></span></span></span></p>
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| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 79px;" | <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">614</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: 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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<span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:"><span style="color:#001133">CPK (activity)</span></span></span>'''</span>
 +
 +
| style="border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: white; width: 109px;" | <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">12 hours</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: 79px;" | <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">1,828</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: 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="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Comments:</span>'''
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">1. Multicentre study with considerable loss of data, no intention to treat analysis and no blinding. There is some danger of bias.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">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.</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Expiry date:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> June 2021</span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Comments:</span></span></span>'''</span></span>
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">References: </span>'''
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">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>
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<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">1. Multicentre study with considerable loss of data, no intention to treat analysis and no blinding. There is some danger of bias.</span></span></span></span></span>
 +
 
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<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">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.</span></span></span></span></span>
 +
 
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Appraised by:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital [mailto:m.bennett@unsw.edu.au m.bennett@unsw.edu.au]</span></span></span><span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Sydney; Friday, 4 June 1999</span></span></span></span></span>
  
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<span style="display: block; text-align: center;">
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">Expiry date:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:#001133">June 2025</span></span></span></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></span>
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Myocardial_ischaemia|BACK]]'''</span>

Latest revision as of 03:57, 22 August 2022

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.

Citation: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.

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

NNT14 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.

Appraised by:Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital m.bennett@unsw.edu.auSydney; Friday, 4 June 1999

Expiry date:June 2025

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