| I would like to clear up a couple of points.
Clockworkdog's first post: Yes, when people drown their heart stops; however this is due to the massive metabolic insult of hypoxia, possible fluid ingress to the lungs etc, not a primary cardiac event caused by "furring up" of the coronary arteries. The two things are completely different.
As mary pointed out, it is sometimes difficult for anyone, even an experienced doctor with an ECG machine, to tell if this is angina or a heart attack.
Thirdly, while the paper is interesting, it makes no comment on the quality of its sources. Just because the 1950s study was a randomised, double blind study (the "gold standard" of clinical trials) does not make it a good trial, or applicable to todays patients. The study may have inclusion or exclusion criteria we know nothing about, it may have been underpowered, and we know nothing about the statistical significance. Heart attack patients are diagnosed and treated differently these days, often with drugs that produce increased blood flow to the heart, which may offset these effects. The other trials mentioned talk about physiological measurements, but none mention an outcome measure i.e. was there a statistically significant difference in outcoems (e.g patient mortality, development of complications etc).
Lets put it this way, when the next possible heart attack rolls through the door on my take, I would expect him to be on oxygen. If my mum were to have a heart attack, I would want her to have oxygen. There may not be a great deal of evidence for benefit, but there is very little for harm. By the way would anyone be willing to enrol themselves in a randomised trial - if you are having a heart attack, you will be randomised to either oxygen or room air?
PS if the author of the paper can suggest what else we should do if we can demonstrate that the patient is hypoxic apart from turn up the O2, I'd like to hear it.  |