Difference between revisions of "Shandling"
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<span style="font-size:x-large;">'''<span style="font-family: 'Times New Roman','serif';">Hyperbaric oxygen and thrombolysis in the treatment of acute myocardial infarction improved symptom resolution and may limit myocardial damage.</span>'''</span> | <span style="font-size:x-large;">'''<span style="font-family: 'Times New Roman','serif';">Hyperbaric oxygen and thrombolysis in the treatment of acute myocardial infarction improved symptom resolution and may limit myocardial damage.</span>'''</span> | ||
| − | <span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:">Clinical bottom line:</span></span>'''</span> |
| − | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:">1. Administration of HBO and thrombolysis together is feasible and is not associated with poor outcomes.</span></span></span> |
| − | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:">2. Myocardial damage, as estimated by enzyme rise, may be less in the HBO group.</span></span></span> |
| − | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:">3. There is earlier resolution of pain with HBO.</span></span></span> |
| − | + | <span style="font-size:large;">'''<span style="font-family: 'Times New Roman','serif';">References:</span>'''<span style="font-family: 'Times New Roman','serif';">1.Shandling AH, Ellestad MH, Hart GB, Crump R, Marlow D, Van Natta B, Messenger JC, Strauss M, Stavitsky Y. Hyperbaric oxygen and thrombolysis in myocardial infarction: The "HOT MI" pilot study. American Heart Journal 1997; 134:544-550.</span></span> | |
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| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:">Clinical Scenario:</span></span>'''<span style="font-size:13.5pt"><span style="font-family:">A 55-year-old man with suspected myocardial infarction presenting to the Emergency Department.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:">Three-part Question:</span></span>'''<span style="font-size:13.5pt"><span style="font-family:">In evolving myocardial infarction where thrombolysis is considered appropriate, does the addition of hyperbaric oxygenation compared to thrombolysis alone, result in any improvement in outcome? '''Search Terms''': Hyperbaric oxygenation, myocardial infarction.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:">The Study:</span></span>'''<span style="font-size:13.5pt"><span style="font-family:">Non-blinded concealed randomised controlled trial without intention-to-treat. Presentation with suspected MI, pain duration less than six hours and considered suitable for rTPA administration.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:">Control group</span></span>'''<span style="font-size:13.5pt"><span style="font-family:">(N = 41; 34 analysed): Usual cardiac care including rTPA, total dose 100mg.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:">Experimental group</span></span>'''<span style="font-size:13.5pt"><span style="font-family:">(N = 41; 32 analysed): As above, but transferred immediately to hyperbaric chamber for a single session at 2ATA for 60 minutes on 100%oxygen.</span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:14.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:14.5pt"><span style="font-family:">The Evidence:</span></span>'''</span> |
{| class="Table" style="border:solid windowtext 1.0pt" | {| class="Table" style="border:solid windowtext 1.0pt" | ||
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| − | | style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Outcome</span></span>'''</span></p> |
| − | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><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 align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">RTPA rate</span></span>'''</span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">HBO rate</span></span>'''</span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Relative risk reduction</span></span>'''</span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Absolute risk reduction</span></span>'''</span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">NNT</span></span>'''</span></p> |
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| style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | | style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Death</span></span>'''</span> |
| − | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">Discharge</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.06</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><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 align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">100%</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.059</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">17</span></span></span></p> |
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| − | | colspan="5" style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | colspan="5" style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">95% CI:</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-0.02 to 0.14</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">NNT '''7 '''to INF NNH 49 to INF</span></span></span></p> |
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| style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | | style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Revascularization</span></span>'''</span> |
| − | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">Discharge</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.56</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.59</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-6%</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-0.035</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-29</span></span></span></p> |
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| style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | | style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">95% CI:</span></span>'''</span> |
| style="width:62.75pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="86" | | | style="width:62.75pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="86" | | ||
| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | | style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | ||
| style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | | style="border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" | | ||
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-49% to 36%</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-0.27 to 0.20</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">NNT 5 to INF NNH 4 to INF</span></span></span></p> |
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| style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | | style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Balloon pump</span></span>'''</span> |
| − | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">Discharge</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.12</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.03</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">74%</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.087</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">11</span></span></span></p> |
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| − | | colspan="4" style="width:249.65pt; border:solid windowtext 1.0pt" width="376" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | colspan="4" style="width:249.65pt; border:solid windowtext 1.0pt" width="376" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">95% CI:</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-31% to 100%</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-0.04 to 0.21</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">NNT 5 to INF NNH 27 to INF</span></span></span></p> |
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| − | + | | style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Non-event outcomes</span></span>'''</span></p> | |
| − | + | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><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 align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">rTPA group</span></span>'''</span></p> | |
| − | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">HBO and rTPA group</span></span>'''</span></p> | |
| − | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">P-value</span></span>'''</span></p> | |
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| − | | style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | ||
| − | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | ||
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | ||
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | ||
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | ||
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| style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | | style="width:94.5pt; border:solid windowtext 1.0pt" width="129" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">CPK (activity)</span></span>'''</span> |
| − | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">12 hours</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">2,385</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1,552</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.03</span></span></span></p> |
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| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Pain relief (mins)</span></span>'''</span> |
| − | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">variable</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">664</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">275</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:"><0.001</span></span></span></p> |
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| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">ST resolution (mins)</span></span>'''</span> |
| − | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">variable</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">285</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">185</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">>0.05</span></span></span></p> |
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| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">LOS (days</span></span>'''</span> |
| − | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:62.75pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">variable</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">9.2</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">7.4</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">>0.05</span></span></span></p> |
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| − | <span style="font-size: | + | <span style="font-size:large;">'''<span style="font-family: 'Times New Roman','serif';">Comments:</span>'''</span> |
| − | <span style="font-size: | + | <span style="font-size:large;">1. Small, pilot study without intention to treat. About 50% recruitment rate of eligible patients due to physician refusal. No attempt to blind.</span> |
| − | <span style="font-size: | + | <span style="font-size:large;">2. Larger, multi-centre study with similar protocol is under way.</span> |
| − | <span style="font-size: | + | <span style="font-size:large;">'''<span style="font-family: 'Times New Roman','serif';">Expiry date:</span>'''<span style="font-family: 'Times New Roman','serif';">June 2021</span></span> |
| − | <span style=" | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:">Appraised by: </span></span>'''<span style="font-size:13.5pt"><span style="font-family:">Mike Bennett, Dept.of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney Monday, 14 December, 1998</span></span></span> |
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Latest revision as of 03:55, 22 August 2022
Hyperbaric oxygen and thrombolysis in the treatment of acute myocardial infarction improved symptom resolution and may limit myocardial damage.
Clinical bottom line:
1. Administration of HBO and thrombolysis together is feasible and is not associated with poor outcomes.
2. Myocardial damage, as estimated by enzyme rise, may be less in the HBO group.
3. There is earlier resolution of pain with HBO.
References:1.Shandling AH, Ellestad MH, Hart GB, Crump R, Marlow D, Van Natta B, Messenger JC, Strauss M, Stavitsky Y. Hyperbaric oxygen and thrombolysis in myocardial infarction: The "HOT MI" pilot study. American Heart Journal 1997; 134:544-550.
Clinical Scenario:A 55-year-old man with suspected myocardial infarction presenting to the Emergency Department.
Three-part Question:In evolving myocardial infarction where thrombolysis is considered appropriate, does the addition of hyperbaric oxygenation compared to thrombolysis alone, result in any improvement in outcome? Search Terms: Hyperbaric oxygenation, myocardial infarction.
The Study:Non-blinded concealed randomised controlled trial without intention-to-treat. Presentation with suspected MI, pain duration less than six hours and considered suitable for rTPA administration.
Control group(N = 41; 34 analysed): Usual cardiac care including rTPA, total dose 100mg.
Experimental group(N = 41; 32 analysed): As above, but transferred immediately to hyperbaric chamber for a single session at 2ATA for 60 minutes on 100%oxygen.
The Evidence:
Outcome |
Time to Outcome |
RTPA rate |
HBO rate |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
Death |
Discharge |
0.06 |
0 |
100% |
0.059 |
17 |
95% CI: |
-0.02 to 0.14 |
NNT 7 to INF NNH 49 to INF | ||||
|
Revascularization |
Discharge |
0.56 |
0.59 |
-6% |
-0.035 |
-29 |
|
95% CI: |
-49% to 36% |
-0.27 to 0.20 |
NNT 5 to INF NNH 4 to INF | |||
|
Balloon pump |
Discharge |
0.12 |
0.03 |
74% |
0.087 |
11 |
95% CI: |
-31% to 100% |
-0.04 to 0.21 |
NNT 5 to INF NNH 27 to INF | |||
Non-event outcomes |
Time to outcome |
rTPA group |
HBO and rTPA group |
P-value | ||
|
CPK (activity) |
12 hours |
2,385 |
1,552 |
0.03 | ||
|
Pain relief (mins) |
variable |
664 |
275 |
<0.001 | ||
|
ST resolution (mins) |
variable |
285 |
185 |
>0.05 | ||
|
LOS (days |
variable |
9.2 |
7.4 |
>0.05 | ||
Comments:
1. Small, pilot study without intention to treat. About 50% recruitment rate of eligible patients due to physician refusal. No attempt to blind.
2. Larger, multi-centre study with similar protocol is under way.
Expiry date:June 2021
Appraised by: Mike Bennett, Dept.of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney Monday, 14 December, 1998
