An audit of paramedic administration of oxygen therapy to patients with suspected acute coronary syndrome

Abstract

Introduction In the past, high flow oxygen was routinely administered to patients with suspected acute myocardial infarction. Recent evidence has suggested there is no benefit from hyperoxaemia, and in these patients it might result in adverse outcomes. The Australian and New Zealand Council of Resuscitation (ANZCOR) guideline previously recommended routine oxygen therapy, but a recent change has occurred. The ANZCOR current guideline recommends selective use of oxygen therapy in patients with suspected acute myocardial infarction, to achieve oxygen saturations ≥94% and <98%. Because the change occurred recently, the South Australian paramedic adherence rate to the ANZCOR guideline was unknown. Therefore, the aim of this study was to determine the South Australian paramedic adherence rate to the ANZCOR oxygen use in acute coronary syndrome recommendations. Methods A retrospective audit of patient case notes was conducted, for patients with chest pain presenting via ambulance to a tertiary hospital emergency department, during a 3-month period. Paramedic administration of oxygen therapy was then compared against the ANZCOR recommendations. Results Paramedics treated a total of 111/139 (79.9%, CI 72.4–85.7%) in line with the ANZCOR guideline and the treatment of 28/139 (20.1%, CI 14.3–27.6%) fell outside of the recommendations. Conclusion Although the results demonstrated a degree of compliance, this could be improved through clinical education, a review of the local chest pain guidelines, an introduction of a drug protocol for oxygen therapy and future research investigating the reasons for non-compliance to the best practice guidelines.