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ANZCOR 9.2.10 - Oxygen

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Summary

Who does this guideline apply to?

This guideline applies to adults, children and infants.

Who is the audience for this guideline?

This guideline is for use by bystanders, first aiders and first aid training providers.

Recommendations

The Australian and New Zealand Committee on Resuscitation (ANZCOR) makes the following recommendations:

  1. Basic Life Support measures should never be delayed whilst waiting for oxygen or other equipment. [Good Practice Statement]
  2. The administration of supplemental oxygen should be limited to individuals with specific training in oxygen administration.1,2 [Good Practice Statement]
  3. When bag-valve-mask oxygen resuscitation is used by trained but occasional operators, a minimum of two trained rescuers are required to provide ventilation for a non-breathing person. [Good Practice Statement]
  4. Persons who require supplemental oxygen in a first aid setting be further evaluated by a health care professional. [Good Practice Statement].

Abbreviations

ANZCOR- Australian and New Zealand Committee on Resuscitation CoSTR- Consensus on Science with Treatment Recommendations (from International Liaison Committee on Resuscitation - ILCOR) ANZTS- Australia and New Zealand Thoracic Society

Guideline

1 Introduction

Administration of supplemental oxygen is traditionally considered essential for individuals presenting with shortness of breath, difficulty breathing, or hypoxemia (low oxygen level in the blood). In certain circumstances, oxygen supplementation might have adverse effects that complicate the disease course or even worsen clinical outcomes.1 The administration of supplemental oxygen should be limited to individuals with specific training in oxygen administration.1,2 [Good practice statement]

There is evidence to support the use of oxygen as part of first aid management of decompression illness1 and for shortness of breath (dyspnoea) in cancer patients with hypoxaemia.1

The use of oxygen delivery devices, such as bag-valve-mask equipment and oxygen powered resuscitation equipment, should also only be undertaken by those who are trained in their use (with current training and certification). [Good Practice Statement]

2 Equipment

There are many types of oxygen delivery devices available, ranging from the simple oxygen mask, which can be used with very little training, to the more complex bag-valve-mask ventilation equipment.

It is recommended that when bag-valve-mask oxygen resuscitation is used, a minimum of two trained people are required to provide ventilation for a non-breathing person: one to manage the airway, mask and seal, and the second to operate the bag.3 [Good Practice Statement]

If two trained people are not available to provide ventilation for a non-breathing person then mouth- to-mask breathing using a resuscitation face mask with supplemental oxygen will provide adequate oxygenation and ventilation.4 [Refer to ANZCOR Guideline 5].

3 Management

Basic Life Support measures should never be delayed whilst waiting for oxygen or other equipment.6 [Good Practice Statement]

In the non-breathing person, oxygen may be used if available by mouth-to-mask, bag-valve- mask or positive pressure oxygen delivery system, if the appropriate equipment and personnel with current training and certification in its use are available. [Good Practice Statement]

A person who requires supplemental oxygen in a first aid setting requires further assessment by a health care professional so an ambulance must always be sent for.

3.1 Use of pulse oximetry

It is best practice that the use of supplemental oxygen is guided by pulse oximetry 2,5 [TSANZ Grade C recommendation: ‘Body of evidence provides some support for recommendation(s) but care should be taken in its application’ ].5

Oxygen should be administered to persons with an oxygen saturation of less than 92%.5

Oxygen should be given to persons signs with cyanosis (blue colouration of skin), shock including from major injury,2 decompression illness6 or a situation suggesting carbon monoxide poisoning7 (eg. house fire) irrespective of their oxygen saturation level or whether pulse oximetry is available.

3.2 Oxygen administration in specific circumstances

Conditions where oxygen is recommended include:

  • during cardiopulmonary resuscitation [Refer to ANZCOR Guideline 11.1.1 and ANZCOR Guideline 12.2]
  • bleeding [Refer to ANZCOR Guideline 9.1.1]
  • burns [Refer to ANZCOR Guideline 9.1.3]
  • shock [Refer to ANZCOR Guideline 9.2.3]
  • asthma [Refer to ANZCOR Guideline 9.2.5]
  • anaphylaxis [Refer to ANZCOR Guideline 9.2.7]
  • drowning [Refer to ANZCOR Guideline 9.3.2]
  • decompression illness [Refer to ANZCOR Guideline 9.3.5]
  • poisoning [Refer to ANZCOR Guideline 9.5.1].

Oxygen use in persons with stroke [Refer to ANZCOR Guideline 9.2.2] and heart attack [Refer to ANZCOR Guideline 9.2.1] who do not have signs of shock should be guided by pulse oximetry as excessive oxygen may be harmful in these conditions.2,5,8-10 ANZCOR suggests against the routine administration of oxygen in persons with stroke.11,12 [2020 CoSTR, weak recommendation, low-to- moderate certainty evidence] ANZCOR suggests that for persons with stroke, the routine use of oxygen is not recommended if the oxygen saturation is >92% on room air [National Stroke Foundation: weak recommendation, moderate-to-high certainty evidence].8

ANZCOR suggests against the routine administration of oxygen in persons with chest pain.13 [ COSTR, weak recommendation, very-low certainty evidence] For persons with heart attack, routine use of oxygen is not recommended if the oxygen saturation is >93% [National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: practice advice].9

References

  1. Zideman DA, Singletary EM, De Buck EDJ, et al. Part 9: First aid 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2015; 95 : e225-e61.
  2. O’Driscoll BR, Howard L, Earis J, et al. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax 2017; 72 (Suppl 1): ii1-ii90.
  3. Jesudian MC, Harrison RR, Keenan RL, Maull KI. Bag-valve-mask ventilation; two rescuers are better than one: preliminary report. Crit Care Med 1985; 13 (2): 122-3.
  4. Harrison RR, Maull KI, Keenan RL, Paul Boyan C. Mouth-to-mask ventilation: A superior method of rescue breathing. Annals of emergency medicine 1982; 11 (2): 74-6.
  5. Beasley R, Chien J, Douglas J, et al. Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: ‘Swimming between the flags’. Respirology 2015; 20 (8): 1182- 91.
  6. Longphre J, Denoble P, Moon R, Vann R, Freiberger J. First aid normobaric oxygen for the treatment of recreational diving injuries. Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc 2007; 34 (1): 43-9.
  7. Wolf SJ, Maloney GE, Shih RD, Shy BD, Brown MD. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Annals of emergency medicine 2017; 69 (1): 98-107.
  8. National Stroke Foundation. Clinical Guidelines for Stroke Management 2017. Chapter 3 of 8: Acute medical and surgical management. Melbourne. Retrieved 20 November 2020 from https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management-2017: National Stroke Foundation, 2017.
  9. Chew D, Scott I, Cullen L, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Med J Aust 2016; 205 (3): 128.
  10. Stub D, Smith K, Bernard S, et al. Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation. 2015 Jun 16;131(24):2143-50.
  11. Singletary EM, Zideman DA, Bendall JC, et al. 2020 International Consensus on First Aid Science With Treatment Recommendations. Circulation 2020; 142 (16_suppl_1): S284-S334.
  12. Singletary EM, Zideman DA, Bendall JC, et al. 2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation 2020; 156 : A240-A82.
  13. Nikolaou NI, Welsford M, Beygui F, et al. Part 5: Acute coronary syndromes 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2015; 95 : e121-e46.

About this Guideline

  • Search date/s November 2020
  • Method: Evidence update based on British Thoracic Society and Thoracic Society of Australia and New Zealand Guidelines
  • Primary reviewers: Julie Considine
  • Other consultation: Finlay Macneil
  • Worksheet: See BTS and TSANZ publications
  • Approved: April 2021
  • Guideline superseded: ANZCOR Guideline 9.2. 10 - January 2016