Abstract 177: Prehospital Oxygen Administration for Chest Pain Patients Decreases Significantly Following Implementation of the 2010 AHA Guidelines
Background: Since 2010, the AHA Emergency Cardiovascular Care guidelines no longer recommend routine administration of supplemental oxygen (O2). This applies to hemodynamically stable patients experiencing chest pain whose oxyhemoglobin saturation (SpO2) is ≥ 94%.1 This study examined trends in prehospital oxygen administration by emergency medical services (EMS) providers following publication of this guideline.
Methods: This retrospective study analyzed data obtained from Fisdap™, a national, clinical skills tracking system for EMS students. Clinical skills are self-reported and then verified by a student’s preceptor. Inclusion criteria included: 1) student consent for research, 2) patient presented with a chief complaint of cardiac chest pain, and 3) SpO2 data recorded. The study time period included data from 6-months prior to publication of the 2010 AHA guidelines through December 31, 2012. Exclusion criteria included: 1) SpO2 < 94%, 2) cases with documented positive pressure ventilation, continuous positive airway pressure, or any other indication of criticality, and 3) patients who could be considered clinically hemodyamically unstable (systolic blood pressure < 100 or > 250; heart rate < 60 or > 100). Unadjusted logistic regression was used to determine if O2 administration changed significantly over the 3 years studied (2010 - 2012).
Results: A total of 10,558 patient encounters by 2,447 paramedic students from 195 paramedic programs across the United States were included for analysis. In 2010, 71.9% (488/1738) of patients with SpO2 ≥ 94% received supplemental O2. Compared to 2010, this rate decreased significantly in 2011 to 64% (1820/5050) and to 53.1% (1767/3770) in 2012 (p < 0.001, respectively). Hemodynamically stable chest pain patients with SpO2 ≥ 94% in 2011 were 1.4 times more likely to not receive supplemental O2 compared to patients in 2010 (95% CI 1.3-1.6). Similarly, patients in 2012 were 2.3 times more likely to not receive supplemental O2 compared to patients in 2010 (95% CI 2.0-2.6).
Conclusion: The prehospital administration of supplemental O2 has decreased significantly following release of the 2010 updated guidelines. However, 50% of patients not meeting criteria for administration still received supplemental O2.
- © 2013 by American Heart Association, Inc.