Identifying the effects of supplemental oxygen administration on the health outcomes of patients presenting with acute coronary syndrome and oxygen saturation 93% – a systematic review

Objectives: Oxygen was commonly used in the early management of patients presenting with Acute Coronary Syndrome (ACS) regardless of their oxygen saturation. Inappropriate administration of supplemental oxygen could potentially result in adverse patient health outcomes.

Aim: To identify the effects of supplemental oxygen administration on the health outcomes of patients presenting with ACS and oxygen saturations >93%.

Method: Systematic review. The CINAHL, PubMed, Cochrane and Medline databases were searched for relevant literature. Inclusion criteria included articles published from 2008-2019, adult participants, primary studies, and participants with uncomplicated ACS and have oxygen saturation >93%. Eligible studies were assessed for rigour using a critical appraisal tool.

Results: Seven randomised controlled studies were included for analysis. Themes were also used to group the assessed endpoints. The three main outcomes analysed were: infarct size and cardiac function; adverse cardiac events; and mortality. Two of the seven studies found a statistically significant relationship between oxygen administration, infarct size, and adverse cardiac events. Conversely, five of the seven studies reported that supplemental oxygen did not have statistically significant benefit over room air.

Conclusion: This review identified that oxygen should not be administered to patients who present with ACS and have oxygen saturations >93%. This is due to the potential risk of adverse outcomes: increased infarct size, mortality, and adverse events.

Impact statement: Recent update of guidelines despite evidence opposing oxygen delivery in ACS means the education of nurses is imperative for safe practice.

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