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Routine Oxygen Supplementation in Acute Cardiovascular Disease: The End of a Paradigm?

Supplemental oxygen has been a cornerstone of supportive care in cardiovascular medicine for decades. In the scenario of acute myocardial infarction (MI), the mnemonic MONA has been taught to medical students and professionals for generations, helping them to remember the initial treatment morphine, oxygen, nitroglycerin, and aspirin. Specifically, the utility of supplemental oxygen has been challenged lately, questioning the need for this ubiquitous therapy based on limited scientific evidence. Similarly, oxygen therapy has been used liberally in patients with acute stroke and other acute cardiovascular diseases in the prehospital and hospital settings more based on therapeutic tradition than conclusive data from randomized clinical trials (RCTs). Is it time for MONA to stop greeting patients with cardiovascular disease at the door?

The rationale behind supplemental oxygen in the acute setting has been to increase oxygen delivery to the ischemic heart, brain, or other organs. In the hypoxemic patient (hypoxemia defined as oxygen saturation <90%), this approach seems reasonable. However, most of the patients today are not hypoxemic at baseline, and supplying oxygen therapy to normoxemic patients (normoxemia defined as oxygen saturation ≥90%) may not only be unnecessary but might even involve risks. Above normal oxygen tension in the …