Oxygen is STILL Not the Wonder Drug

Over the years, we’ve published several articles on oxygen administration and hypoxia. Over those same years, the guidelines for administering oxygen have changed several times. We’ve adapted and revised each time they’ve changed.

In 2015 we published an article titled “Oxygen is the Wonder Drug No More.” It was five years after the initial 2010 American Heart Association oxygen guidelines were published, redefining hypoxia and reshaping thinking on how oxygen was administered.

Changing Guidelines for Oxygen Administration

We are 15 years past that momentous 2010 guidelines release and about to experience another AHA guideline release later this year. While we don’t know everything that will be in the guidelines, a recent position paper by the American Heart Association, the National Association of EMS Physicians (NAEMSP), and the American College of Emergency Physicians (ACEP) further clarified the definition of hypoxia for patients with suspected acute coronary syndrome to less than 90%. The target for saturation after oxygen administration is >90%.

Oxygen doesn’t make patients miraculously “feel better” or reduce non-hypoxic anxiety.

We had a visceral reaction in 2010 when we learned oxygen may actually be harmful. We’ve gradually—but not fully—acknowledged that oxygen is a drug with an indication (hypoxia). It doesn’t make patients miraculously “feel better,” as many proclaim, or reduce non-hypoxic anxiety.

Oxygen Administration Flowchart

Four-Step Critical Thinking Approach to Oxygen

To highlight these considerations, we’re adding one more item to the decision-making toolbox for administering oxygen: our four-step process for determining whether to administer oxygen. It is really about more than saturation numbers. It is about clinical decision making based on a number of factors. 

Our newest chart helps EMS providers move past the (saturation) numbers game and look at the whole patient and situation to make an appropriate oxygenation decision.

And great EMS is ultimately a series of good decisions.