It has been an article of faith, enshrined in the mnemonic MONA, to give supplemental oxygen to patients having heart attacks. (MONA is morphine, oxygen, nitrates, aspirin) The idea of course is that heart muscle is dying during a heart attack because a blood clot causes a lack of blood flow and oxygen deprivation.

A recent randomized controlled trial has shown that giving oxygen makes things worse!

With this, we should drop the “O” in MONA . Maybe it should be “MAN.”

An issue of the sharp end several years back that I contributed to covered this very issue, along with other previous bits of dogma that have been overturned.

Room for thought: Is it possible that healing mechanisms after acute coronary syndrome have evolved to perform best in the absence of extra oxygen?

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Joe Alcock

Emergency Physician, Educator, Researcher, interested in the microbiome, evolution, and medicine