Pre-hospital treatment of supraventricular tachycardia: a literature review

Abstract

Background: Tachycardia is a common finding within the unwell patient and can occur as a normal physiological response or as a result of an underlying arrhythmia. Supraventricular tachycardia (SVT) is a common cardiac arrhythmia which can be treated through a range of differing techniques. The aim of this review was to identify whether the current evidence base supports UK paramedic practice and whether the treatment provided could be enhanced. Methods: A literature review through the databases CINAHL, Pubmed and Medline was carried out, using a Boolean search strategy. Articles were included within the study if they discussed the management of SVT through the use of the Valsalva manoeuvre, carotid sinus massage or adenosine within the hospital or pre-hospital environment. Results: A total of 32 papers were identified for possible inclusion, with 18 papers being included. The Valsalva manoeuvre was shown to be the most effective vagal manoeuvre, with reversion rates of 21.4–27.7% within the pre-hospital environment. The use of adenosine was shown to be effective in reverting SVT, with most total reversion rates being 80.7–100%. The initial 6 mg dose was shown to have lower efficacy than the subsequent 12 mg doses. Correct paramedic identification rates of SVT were greater than 75%. Conclusions: The Valsalva manoeuvre has been shown to be effective and potentially more effective the quicker it is used following onset of the SVT. The safe use of adenosine by paramedics within the US and Australia support the introduction of adenosine into UK paramedic practice.