Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-14T07:27:46.916Z Has data issue: false hasContentIssue false
  • English
  • Français

Implementation of a Titrated Oxygen Protocol in the Out-of-Hospital Setting

Published online by Cambridge University Press:  01 July 2014

Nichole Bosson ,
Marianne Gausche-Hill  and
William Koenig
Nichole Bosson*
Affiliation:
Los Angeles County Emergency Medical Services Agency, Los Angeles, California USA Department of Emergency Medicine Harbor-UCLA Medical Center, Torrance, California USA Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California USA David Geffen School of Medicine at UCLA, Los Angeles, California USA
Marianne Gausche-Hill
Affiliation:
Department of Emergency Medicine Harbor-UCLA Medical Center, Torrance, California USA Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California USA David Geffen School of Medicine at UCLA, Los Angeles, California USA
William Koenig
Affiliation:
Los Angeles County Emergency Medical Services Agency, Los Angeles, California USA
*
Correspondence: Nichole Bosson, MD, MPH Harbor-UCLA Medical Center 1000 W Carson Street, Building D9 Box 21 Torrance, CA 90509 USA E-mail [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Oxygen is one of the most frequently-used therapeutic agents in medicine and the most commonly administered drug by prehospital personnel. There is increasing evidence of harm with too much supplemental oxygen in certain conditions, including stroke, chronic obstructive pulmonary disease (COPD), neonatal resuscitations, and in postresuscitation care. Recent guidelines published by the British Thoracic Society (BTS) advocate titrated oxygen therapy, but these guidelines have not been widely adapted in the out-of-hospital setting where high-flow oxygen is the standard. This report is a description of the implementation of a titrated oxygen protocol in a large urban-suburban Emergency Medical Services (EMS) system and a discussion of the practical application of this out-of-hospital protocol.

Bosson N, Gausche-Hill M, Koenig W. Implementation of a Titrated Oxygen Protocol in the Out-of-Hospital Setting. Prehosp Disaster Med. 2014;28(4):1-6 .

Keywords

Emergency Medical Servicesoxygenresuscitation
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 4 , August 2014 , pp. 403 - 408
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. O'Driscoll, BR, Howard, LS, Davison, AG. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008;63(Suppl 6):vi1-vi68.Google Scholar
2. Macnab, AJ, Susak, L, Gagnon, FA, Alred, J, Sun, C. The cost-benefit of pulse-oximeter use in the prehospital environment. Prehosp Disaster Med. 1999;14(4):245-250.Google Scholar
3. Los Angeles County EMS Agency EMS System Report. 2013. http://ems.dhs.lacounty.gov/Reports/EMSAnnualDataReport2013.pdf. Accessed November 12, 2013.Google Scholar
4. Department of Health Services, County of Los Angeles, Reference No 1304. Medical Control Guideline: Airway Management and Monitoring. http://ems.dhs.lacounty.gov/policies/Ref1200/Ref1200.htm. Accessed November 12, 2013.Google Scholar
5. Davis, DP, Meade, W, Sise, MJ, et al. Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury. J Neurotrauma. 2009;26(12):2217-2223.Google Scholar
6. Joosten, SA, Koh, MS, Bu, X, Smallwood, D, Irving, LB. The effects of oxygen therapy in patients presenting to an emergency department with exacerbation of chronic obstructive pulmonary disease. Med J Aust. 2007;186(5):235-238.Google Scholar
7. Plant, PK, Owen, JL, Elliott, MW. One year period prevalence study of respiratory acidosis in acute exacerbations of COPD: implications for the provision of non-invasive ventilation and oxygen administration. Thorax. 2000;55(7):550-554.CrossRefGoogle ScholarPubMed
8. Wijesinghe, M, Perrin, K, Healy, B, et al. Pre-hospital oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. Intern Med J. 2011;41(8):618-622.Google Scholar
9. Austin, MA, Wills, KE, Blizzard, L, Walters, EH, Wood-Baker, R. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010;341:c5462.CrossRefGoogle ScholarPubMed
10. Thompson, J, Petrie, DA, Ackroyd-Stolarz, S, Bardua, DJ. Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: a randomized controlled trial. Ann Emerg Med. 2008;52(3):232-241, 41 e1.Google Scholar
11. Cason, BA, Wisneski, JA, Neese, RA, et al. Effects of high arterial oxygen tension on function, blood flow distribution, and metabolism in ischemic myocardium. Circulation. 1992;85(2):828-838.Google Scholar
12. Cabello, JB, Burls, A, Emparanza, JI, Bayliss, S, Quinn, T. Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev. 2013;8:CD007160.Google Scholar
13. Wijesinghe, M, Perrin, K, Ranchord, A, Simmonds, M, Weatherall, M, Beasley, R. Routine use of oxygen in the treatment of myocardial infarction: systematic review. Heart. 2009;95(3):198-202.CrossRefGoogle ScholarPubMed
14. Nicholson, C. A systematic review of the effectiveness of oxygen in reducing acute myocardial ischaemia. J Clin Nurs. 2004;13(8):996-1007.CrossRefGoogle ScholarPubMed
15. Kones, R. Oxygen therapy for acute myocardial infarction-then and now. A century of uncertainty. Am J Med. 2011;124(11):1000-1005.Google Scholar
16. Moradkhan, R, Sinoway, LI. Revisiting the role of oxygen therapy in cardiac patients. J Am Coll Cardiol. 2010;56(13):1013-1016.Google Scholar
17. McNulty, PH, King, N, Scott, S, et al. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol. 2005;288(3):H1057-H1062.Google Scholar
18. Singhal, AB. A review of oxygen therapy in ischemic stroke. Neurol Res. 2007;29(2):173-183.Google Scholar
19. Ronning, OM, Guldvog, B. Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke. 1999;30(10):2033-2037.Google Scholar
20. Neumar, RW. Optimal oxygenation during and after cardiopulmonary resuscitation. Curr Opin Crit Care. 2011;17(3):236-240.Google Scholar
21. Brucken, A, Kaab, AB, Kottmann, K, et al. Reducing the duration of 100% oxygen ventilation in the early reperfusion period after cardiopulmonary resuscitation decreases striatal brain damage. Resuscitation. 2010;81(12):1698-1703.CrossRefGoogle ScholarPubMed
22. Balan, IS, Fiskum, G, Hazelton, J, Cotto-Cumba, C, Rosenthal, RE. Oximetry-guided reoxygenation improves neurological outcome after experimental cardiac arrest. Stroke. 2006;37(12):3008-3013.CrossRefGoogle ScholarPubMed
23. Kilgannon, JH, Jones, AE, Shapiro, NI, et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010;303(21):2165-2171.Google Scholar
24. Kilgannon, JH, Jones, AE, Parrillo, JE, et al. Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation. 2011;123(23):2717-2722.CrossRefGoogle ScholarPubMed
25. Deakin, CD, Nolan, JP, Soar, J, et al. European Resuscitation Council Guidelines for Resuscitation 2010, Section 4. Adult Advanced Life Support. Resuscitation. 2010;81(10):1305-1352.Google Scholar
26. Knight, AR, Fry, LE, Clancy, RL, Pierce, JD. Understanding the effects of oxygen administration in haemorrhagic shock. Nurs Crit Care. 2011;16(1):28-35.Google Scholar
27. Stockinger, ZT, McSwain, NE Jr. Prehospital supplemental oxygen in trauma patients: its efficacy and implications for military medical care. Mil Med. 2004;169(8):609-612.Google Scholar
28. Lefkowitz, W. Oxygen and resuscitation: beyond the myth. Pediatrics. 2002;109(3):517-519.Google Scholar
29. Feet, BA, Medbo, S, Rootwelt, T, Ganes, T, Saugstad, OD. Hypoxemic resuscitation in newborn piglets: recovery of somatosensory evoked potentials, hypoxanthine, and acid-base balance. Pediatr Res. 1998;43(5):690-696.Google Scholar
30. Kattwinkel, J, Perlman, JM, Aziz, K, et al. Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S909-S919.Google Scholar
31. Ramji, S, Ahuja, S, Thirupuram, S, Rootwelt, T, Rooth, G, Saugstad, OD. Resuscitation of asphyxic newborn infants with room air or 100% oxygen. Pediatr Res. 1993;34(6):809-812.Google Scholar
32. Solas, AB, Kalous, P, Saugstad, OD. Reoxygenation with 100 or 21% oxygen after cerebral hypoxemia-ischemia-hypercapnia in newborn piglets. Biol Neonate. 2004;85(2):105-111.Google Scholar
33. Solas, AB, Kutzsche, S, Vinje, M, Saugstad, OD. Cerebral hypoxemia-ischemia and reoxygenation with 21% or 100% oxygen in newborn piglets: effects on extracellular levels of excitatory amino acids and microcirculation. Pediatr Crit Care Med. 2001;2(4):340-345.Google Scholar
34. Solas, AB, Munkeby, BH, Saugstad, OD. Comparison of short- and long-duration oxygen treatment after cerebral asphyxia in newborn piglets. Pediatr Res. 2004;56(1):125-131.Google Scholar
35. Huang, CC, Yonetani, M, Lajevardi, N, Delivoria-Papadopoulos, M, Wilson, DF, Pastuszko, A. Comparison of postasphyxial resuscitation with 100% and 21% oxygen on cortical oxygen pressure and striatal dopamine metabolism in newborn piglets. J Neurochem. 1995;64(1):292-298.Google Scholar
36. Davis, PG, Tan, A, O'Donnell, CP, Schulze, A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis. Lancet. 2004;364(9442):1329-1333.Google Scholar
37. Rabi, Y, Rabi, D, Yee, W. Room air resuscitation of the depressed newborn: a systematic review and meta-analysis. Resuscitation. 2007;72(3):353-363.Google Scholar
38. Vento, M, Asensi, M, Sastre, J, Garcia-Sala, F, Pallardo, FV, Vina, J. Resuscitation with room air instead of 100% oxygen prevents oxidative stress in moderately asphyxiated term neonates. Pediatrics. 2001;107(4):642-647.Google Scholar
39. Wang, CL, Anderson, C, Leone, TA, Rich, W, Govindaswami, B, Finer, NN. Resuscitation of preterm neonates by using room air or 100% oxygen. Pediatrics. 2008;121(6):1083-1089.Google Scholar
40. Rabi, Y, Yee, W, Chen, SY, Singhal, N. Oxygen saturation trends immediately after birth. J Pediatr. 2006;148(5):590-594.CrossRefGoogle ScholarPubMed
41. Mariani, G, Dik, PB, Ezquer, A, et al. Pre-ductal and post-ductal O2 saturation in healthy term neonates after birth. J Pediatr. 2007;150(4):418-421.Google Scholar
42. Dawson, JA, Kamlin, CO, Vento, M, et al. Defining the reference range for oxygen saturation for infants after birth. Pediatrics. 2010;125(6):e1340-e1347.Google Scholar
43. Saugstad, OD, Rootwelt, T, Aalen, O. Resuscitation of asphyxiated newborn infants with room air or oxygen: an international controlled trial: the Resair 2 study. Pediatrics. 1998;102(1):e1.Google Scholar
44. O'Donnell, CP, Kamlin, CO, Davis, PG, Carlin, JB, Morley, CJ. Clinical assessment of infant colour at delivery. Arch Dis Child Fetal Neonatal Ed. 2007;92(6):F465-F467.Google Scholar
45. Berg, MD, Schexnayder, SM, Chameides, L, et al. Part 13: pediatric Basic Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S862-S875.Google ScholarPubMed
46. Kleinman, ME, Chameides, L, Schexnayder, SM, et al. Part 14: pediatric Advanced Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S876-S908.Google ScholarPubMed
47. Kleinman, ME, de Caen, AR, Chameides, L, et al. Pediatric Basic and Advanced Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics. 2010;126(5):e1261-e1318.Google Scholar
48. Airway management and mask ventilation of the newborn infant. ARC and NZRC Guideline 2010. Emerg Med Australas. 2011;23(4):428-435.Google Scholar