Chest Pain


COCHRANE SYSTEMATIC REVIEW: Hyperbaric oxygen therapy for acute coronary syndrome
Implications for practice: Transport to a Hyperbaric capable facility should be consisdered for pts with ACS.
Review Overview: Hyperbaric oxygen therapy is sometimes used as a treatment to increase the supply of oxygen to the damaged heart in an attempt to reduce the area of the heart that is at risk of dying. Overall, we found some evidence that people with ACS are less likely to die or to have major adverse cardiac events, and to have more rapid relief form their pain, if they receive hyperbaric oxygen therapy as part of their treatment. However, these conclusions are based on six relatively small randomized controlled trials.
LINK to Cochrane Library: Issue 8, 2011 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004818.pub3/pdf/abstract


COCHRANE SYSTEMATIC REVIEW: Intravenous magnesium for acute myocardial infarction
Implications for practice: Unlikely to be effective
Review Overview: In some countries, intravenous (IV) magnesium is given early after a heart attack to patients to reduce mortality or damage to the heart; although there is controversy about this approach. The interpretation of 26 trials in this review is complicated by the likelihood of publication bias and heterogeneity of treatment effects. Giving IV Magnesium is unlikely to reduce mortality but it reduced the incidence of serious arrhythmias. However, this treatment also increased the incidence of profound hypotension, bradycardia and flushing.
LINK to Cochrane Library: Issue 2 2007 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002755/frame.html


COCHRANE SYSTEMATIC REVIEW: Heparin versus placebo for acute coronary syndromes
Implications for practice: Appears effective but increased minor bleeds
Review Overview: Blood clots in the arteries leading to the heart can cause acute coronary syndromes which include unstable angina or a type of heart attack (non-ST segment myocardial infarction - NSTEMI). The research was reviewed to determine if drugs such as heparin may prevent these clots from forming. Eight trials of over 3,000 patients were reviewed where two types of heparin were given to patients with high-risk unstable angina or NSTEMI in addition to standard therapy with aspirin. The heparins prevented more heart attacks than placebo but did not reduce mortality, the need for revascularization procedures or recurrent angina. The use of the heparins caused more cases of minor bleeding.
LINK to Cochrane Library: Issue 2 2008 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003462/frame.html


COCHRANE SYSTEMATIC REVIEW: Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction
Implications for practice: To assess the morbidity and mortality of pre-hospital versus in-hospital thrombolysis for STEMI.
Review Overview: Pre-hospital thrombolysis reduces time to treatment, based on studies conducted in higher income countries. In settings where it can be safely and correctly administered by trained staff, pre-hospital thrombolysis may be an appropriate intervention. Pre-hospital thrombolysis has the potential to reduce the burden of STEMI in lower- and middle-income countries, especially in individuals who have limited access to in-hospital thrombolysis or percutaneous coronary interventions. We found no randomised controlled trials evaluating the efficacy of pre-hospital thrombolysis for STEMI in lower- and middle-income countries. Large high-quality multicentre randomised controlled trials implemented in resource-constrained countries will provide additional evidence for the efficacy and safety of this intervention. Local policy makers should consider their local health infrastructure and population distribution needs. These considerations should be taken into account when developing clinical guidelines for pre-hospital thrombolysis.
LINK to Cochrane Library: Issue 9, 2014 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010191.pub2/abstract