DETermination of the role of OXygen in suspected Acute Myocardial Infarction trial

Robin Hofmann; Stefan K James; Leif Svensson; Nils Witt; Mats Frick; Bertil Lindahl; Ollie Östlund; Ulf Ekelund; David Erlinge; Johan Herlitz; Tomas Jernberg

doi:10.1016/j.ahj.2013.09.022

DETermination of the role of OXygen in suspected Acute Myocardial Infarction trial

Am Heart J. 2014 Mar;167(3):322-8. doi: 10.1016/j.ahj.2013.09.022. Epub 2013 Dec 19.

Authors

Affiliations

¹ Karolinska Institutet, Department of Clinical Science and Education, Division of Cardiology, Södersjukhuset, Stockholm, Sweden. Electronic address: robin.hofmann@ki.se.
² Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
³ Karolinska Institutet, Department of Clinical Science and Education, Division of Cardiology, Södersjukhuset, Stockholm, Sweden.
⁴ Department of Emergency Medicine, Medical Faculty, Lund University, Lund, Sweden.
⁵ Department of Cardiology, Medical Faculty, Lund University, Lund, Sweden.
⁶ Department of Health Sciences, University of Borås, Borås, Sweden.
⁷ Department of Medicine, Karolinska Institutet, Huddinge, Sweden.

PMID: 24576515
DOI: 10.1016/j.ahj.2013.09.022

Abstract

Background: The use of supplemental oxygen in the setting of suspected acute myocardial infarction (AMI) is recommended in international treatment guidelines and established in prehospital and hospital clinical routine throughout the world. However, to date there is no conclusive evidence from adequately designed and powered trials supporting this practice. Existing data are conflicting and fail to clarify the role of supplemental oxygen in AMI.

Methods: A total of 6,600 normoxemic (oxygen saturation [SpO2] ≥90%) patients with suspected AMI will be randomly assigned to either supplemental oxygen 6 L/min delivered by Oxymask (MedCore Sweden AB, Kista, Sweden) for 6 to 12 hours in the treatment group or room air in the control group. Patient inclusion and randomization will take place at first medical contact, either before hospital admission or at the emergency department. The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry will be used for online randomization, allowing inclusion of a broad population of all-comers. Follow-up will be carried out in nationwide health registries and Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies. The primary objective is to evaluate whether oxygen reduces 1-year all-cause mortality. Secondary end points include 30-day mortality, major adverse cardiac events, and health economy. Prespecified subgroups include patients with confirmed AMI and certain risk groups. In a 3-month pilot study, the study concept was found to be safe and feasible.

Conclusion: The need to clarify the uncertainty of the role of supplemental oxygen therapy in the setting of suspected AMI is urgent. The DETO2X-AMI trial is designed and powered to address this important issue and may have a direct impact on future recommendations.

Trial registration: ClinicalTrials.gov NCT01787110.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Humans
Myocardial Infarction / therapy*
Oxygen Inhalation Therapy*
Registries*
Sweden
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01787110