The following abstract was developed during the 2013 Research Summit and presented at the 2014 NAEMSP Annual Meeting in Tuscon, AZ.

Prehospital Administration of Oxygen for Chest Pain Patients Decreases Signficantly Following Implementation of the 2010 AHA Guidelines

Elliot Carhart, EdD, RRT, NRP1 & Joshua G. Salzman, MA, EMT-B2J

1Jefferson College of Health Sciences, Roanoke, VA

2Regions Hospital, St. Paul, MN

Background: Since 2010, the American Heart Association (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%.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 selfreported 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. 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). The study time period included data from 6 months prior to publication of the 2010 AHA guidelines through December 31, 2012. 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 US paramedic programs 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). The odds of a hemodynamically stable chest pain patient with SpO2 ≥ 94% receiving supplemental oxygen in 2011 were 1.4 times lower compared to patients in 2010 (95% CI 1.3-1.6). Similarly, the odds of patients in 2012 receiving supplemental oxygen were 2.3 times lower compared to patients in 2010 (95% CI 2.0-2.6).

Conclusion: This is the first examination of prehospital administration of supplemental O2 following release of the 2010 updated guidelines. There has been a statistically significant decrease in supplemental O2 administration; however, 50% of patients not meeting criteria for administration are still receiving supplemental O2.

1O'Connor, R. E., Brady, W., Brooks, S. C., Diercks, D., Egan, J., Ghaemmaghami, C., . . . & Yannopoulos, D. (2010). Part 10: Acute Coronary Syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation,122(18). S787S817. doi: 10.1161/CIRCULATIONAHA.110.971028