References
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.
Paramedics are often the first point of call for acutely unwell patients who present with a tachycardia. This tachycardia can be a natural physiological response, or less frequently, an underlying cardiac arrhythmia. Swift (2013) defines a tachyarrhythmia as: ‘where the pulse rate is greater than 100 beats per minute (bpm), with abnormal cardiac conduction present.’
Supraventricular tachycardia (SVT) is a common cardiac tachyarrhythmia that has a prevalence of 2.29 per 1 000 people, with an occurrence of 35 out of 100 000 person-years (Orejarena et al, 1998). SVT is a transient narrow complex tachyarrhythmia (Figure 1) that is associated with a pulse rate of greater than 160 bpm, but typically 180–250 bpm, with an abrupt onset of palpitations. Other common symptoms include syncope, chest pain/tightness and shortness of breath (Whinnet et al, 2012). These typically result in an emergency call to the ambulance service.
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