Leeches And Cupping For Myocardial Ischemia
ironjustice
Sue Hughes
European Society of Cardiology (ESC) Congress 2011
August 29, 2011 (Paris, France) — After listening to the evidence,
more cardiologists believe oxygen is harmful rather than helpful in MI
patients, according to a poll of the audience at a debate on the
subject today at the European Society of Cardiology (ESC) 2011
Congress. Despite this, almost everyone in the audience said oxygen is
still routinely given to all MI patients in their hospitals.
While everyone seemed to agree that a large-scale trial is needed,
taking the protagonist role for giving oxygen, Dr Jose Lopez-Sendon
(La Paz University Hospital, Madrid, Spain) suggested that such a
trial may be difficult to conduct because in an emergency situation it
would be hard to obtain consent from a patient to participate in a
study in which they might not get a treatment that has long been
assumed to be beneficial.
However, after all the arguments for and against oxygen had been
heard, there was an almost unanimous "yes" from the audience when
asked by session chair Dr Salim Yusuf (McMaster University, Hamilton,
ON) whether they would consent to participate in such a trial if they
were an MI patient.
The two debaters had a difficult job reviewing the data for or against
the use of oxygen as so few trials have been conducted, and those that
have been done lack the size or quality to produce meaningful
information. While there is a study in 300 patients now planned, Yusuf
said this was not nearly large enough. "We need a 10 000-patient
trial, not a 300-patient trial," he added.
Lopez-Sendon noted that in a recent survey 98% of health professionals
said they routinely gave oxygen to MI patients because it is
intuitive: "Myocardial ischemia is a lack of oxygen so it is logical
to give oxygen."
He noted that although there are little hard data to support the use
of oxygen in MI patients, a recent survey showed that 55% of health
professionals believe oxygen reduces mortality in this situation, with
only 1.3% saying they thought that it might be detrimental. He said
the practice also gave the perception to patients and clinicians that
something useful was being done, which reduced anxiety. In addition,
most guidelines recommend oxygen for MI patients.
Reviewing the scientific evidence, Lopez-Sendon said it was
conflicting, with some studies suggesting oxygen reduced ST changes,
need for analgesics, severe hypoxemia, and infarct size, while other
studies have suggested it increases coronary vascular resistance and
heart rate and reduces cardiac output.
Brainwashed
Taking the antagonist view, Dr Chaim Lotan (Hadassah Hebrew
University, Jerusalem, Israel) said there were "increasing data
telling us not to use oxygen in MI patients."
"We have been brainwashed into using oxygen," but recent data suggest
it causes harmful effects mainly mediated by vasoconstriction of the
coronary arteries, he argued. "Before I started looking into the data,
I didn't understand how much damage we were causing by giving oxygen."
Only three randomized studies of oxygen in MI patients have been
conducted. As reported by heartwire , a recent meta-analysis of these
studies in a Cochrane review showed the practice to be associated with
a threefold increase in mortality, Lotan noted. "Oxygen is killing
patients. It is a drug and should be evaluated as a drug," he
concluded.
But Lopez-Sendon pointed out that the three studies included in the
review had severe limitations, and there were only 13 deaths in total.
"This is not enough to change practice. We don't have much data either
way--to prove benefit or harm."
Lotan added that oxygen was one of several non–evidence-based
practices--including leeches and cupping glasses--that have been used
in MI patients. "Leeches and cupping glasses do not kill patients, but
oxygen may do so."
Sue Hughes is a journalist for Medscape. She joined theheart.org, part
of the WebMD Professional Network, in 2000. She was previously science
editor of Scrip World Pharmaceutical News. Graduating in pharmacy from
Manchester University, UK, she started her career as a hospital
pharmacist before moving as a journalist to a UK pharmacy trade
publication. She can be reached at Shu...@webmd.net.
Heartwire © 2011 Medscape, LLC
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