Measuring the effectiveness of a revised clinical practice guideline for the pre‐hospital management of supraventricular tachycardia

Abstract

The revised CPG improved pre-hospital SVT reversion success. This expansion of practice has not demonstrated improvements to utilisation or effectiveness of the Valsalva manoeuvre. Adenosine is effective and safe for pre-hospital use.

Safety and efficacy of paramedic treatment of regular supraventricular tachycardia: a randomised controlled trial

“…Small prospective studies have demonstrated that administration of adenosine in a community setting is safe2 3 and there is a good correlation between paramedics' interpretation of the ECG and that of physicians 4 5. In cases where there has been inappropriate administration of adenosine, this had not been associated with adverse outcomes2 6 and, with training, inappropriate administration rates are reduced 7.…”

A modified Valsalva manoeuvre results in greater termination of supraventricular tachycardia than standard Valsalva manoeuvre

“…The results demonstrate higher reversion rates than previously reported 3. However, given that the VM is a primary therapy used by emergency physicians (in hospital), paramedics (out of hospital) and patients (in their own home), there is some limitation to the practical generalisability of the MVM.…”

A Novel Calcium Channel Blocker: Etripamil

“…While controversial, reviews of these maneuvers suggest they have limited effectiveness, with the greatest utility being when they are initiated as close as possible to the start of the PSVT. [51][52][53] In evaluation of current treatments, etripamil appears to be as effective as the intravenous standard of care, with conversion rates of 85-90% for adenosine, 90% for verapamil, and 98% for verapamil using a slow infusion protocol. 8,42,52,54 Overall, etripamil has demonstrated a limited side effect profile, an equivalent efficacy to the standard of care, and the advantage of easy self-administration.…”

“…[51][52][53] In evaluation of current treatments, etripamil appears to be as effective as the intravenous standard of care, with conversion rates of 85-90% for adenosine, 90% for verapamil, and 98% for verapamil using a slow infusion protocol. 8,42,52,54 Overall, etripamil has demonstrated a limited side effect profile, an equivalent efficacy to the standard of care, and the advantage of easy self-administration. Of note, there were 3 rare major adverse effects as well as minor delivery-related side effects seen in both the placebo control and experimental groups, such as congestion, lacrimation, and rhinorrhea.…”