Elsevier

American Heart Journal

Volume 158, Issue 3, September 2009, Pages 371-377
American Heart Journal

Curriculum in Cardiology
Systematic review of studies of the effect of hyperoxia on coronary blood flow

https://doi.org/10.1016/j.ahj.2009.05.037Get rights and content

Background

International guidelines recommend the routine use of oxygen in the initial treatment of myocardial infarction, yet it is uncertain what effect this might have on physiologic and clinical outcomes.

Methods

We undertook a systematic search of Medline, Cochrane Database of Systematic Reviews, EMBASE, and CINHAL using the key words “oxygen,” “coronary blood flow,” “hyperoxia,” and “coronary circulation” to identify human studies involving a measure of coronary blood flow while breathing oxygen and room air. The primary outcome measure was coronary blood flow; secondary outcomes included coronary vascular resistance and myocardial oxygen consumption.

Results

From 2,072 potential publications, there were 6 studies from 4 publications that met the inclusion criteria, with 6 healthy subjects and 61 subjects with cardiac disease. It was not possible to undertake a meta-analysis due to methodological limitations. In the 6 studies, high-concentration oxygen therapy resulted in hyperoxia, with a range in mean Pao2 of 273 to 425 mm Hg. Hyperoxia caused a significant reduction in coronary blood flow (mean change −7.9% to −28.9%, n = 6 studies). Hyperoxia caused a significant increase in coronary vascular resistance (mean change 21.5% to 40.9%, n = 4 studies) and a significant reduction in myocardial oxygen consumption (mean change −15.3% to −26.9%, n = 3 studies).

Conclusions

Hyperoxia from high-concentration oxygen therapy causes a marked reduction in coronary blood flow and myocardial oxygen consumption. These physiologic effects may have the potential to cause harm and are relevant to the use of high-concentration oxygen therapy in the treatment of cardiac and other disorders.

Section snippets

Search strategy

To identify all studies that investigated the effect of oxygen therapy on coronary blood flow, a search using the terms “oxygen” and “coronary blood flow” as well as “hyperoxia” and “coronary circulation” was conducted from Medline, Cochrane Database of Systematic Reviews, EMBASE, and CINHAL in December 2007. The reference lists of all relevant studies were also examined. Particular attention was given to searching for studies before 1950, which would not be included in the electronic reference

Description of studies

Figure 1 shows the QUOROM statement for the search, which identified 2,072 potential publications. There were 4 publications with 6 studies that met the criteria for inclusion in this analysis (Table I).26, 27, 28, 29 Two of the publications reported data on separate subject groups, based on the presence or absence of cardiac disease as follows: Ganz et al26 studied patients with coronary artery disease and those with normal coronary arteries, and Mak et al27 studied patients with stable

Discussion

This systematic review has identified that hyperoxia secondary to high-concentration oxygen therapy results in a marked reduction in coronary blood flow due to an increase in coronary vascular resistance. Hyperoxia also caused a reduction in myocardial oxygen consumption in both healthy subjects and subjects with cardiac disorders including coronary artery disease and congestive heart failure. These physiologic effects, together with the well-recognized reduction in heart rate and cardiac

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