In Defense of Morphine (Part 1)

Discussion, we all know why they performed this study, what they expected it to show, and how it will be cited for years to come. It demonstrates an association between morphine and worse outcomes in patients with ST-elevation acute myocardial infarction (STEMI). I don’t know why everyone has been ganging up on poor old morphine for acute coronary syndrome (ACS)—maybe because it’s been beloved by so many for so long—but while I may not be able to empathize with the hardships of being popular, I sympathize with the hate it’s been receiving and hope to offer some exculpation.   How did we get here? Let’s start with a little back-story. For decades, morphine has been a staple for treating ACS. It was initially thought to reduce myocardial oxygen demand, dilate coronary arteries, and even exert direct myocardial protective effects through μ-opioid receptor agonism—all of which theoretically benefit the ischemic heart. I’ll walk through all the data on this someday (I’ve got three different articles that have been stalled in the “draft” phase for a couple of years), but it suffices to say those benefits, if present, are difficult to detect and almost certainly won’t prevent death or severe morbidity. As a result, we don’t need to administer morphine to every patient with ACS. Heck, I’ve seen it given to asymptomatic patients just because the provider thought they had to as part of the MONA package; that&...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Original Articles Vince DiGiulio Source Type: research