Use of the Valsalva manoeuvre in the prehospital setting: a review of the literature

Abstract

This review has shown that a standard of performance of the VM technique is defined within the medical literature, but no evidence exists to determine its efficacy or use in the prehospital setting. A prehospital study is therefore required to affirm the VM as part of prehospital clinical practice guidelines for SVT.

Leg Lift Valsalva Maneuver for Treatment of Supraventricular Tachycardias

“…3,4 The Valsalva maneuver is a safe and recommended first line treatment for SVT, but with cardioversion rates to sinus rhythm of less than 20%. [5][6][7][8] Patients who have remained in SVT after Valsalva are most often treated with adenosine, which is commonly associated with adverse and frightening effects for patients and requires IV access. 9 Modifications to the standard Valsalva that increase relaxation phase venous return and vagal stimulation may improve cardioversion effectiveness but have not yet been tested in controlled trials.…”

A modification to the Valsalva manoeuvre improves its effectiveness in treating supraventricular tachycardia

“…One of the many applications of the VM is its use for arresting episodes of SVT based on the relatively sudden reduction of heart rate in response to the increased venous return and arterial pressure rise following the Valsalva strain 1 2. The VM provides better results than other vagal manoeuvres (such as the carotid sinus massage or facial immersion),1 and hence it is usually recommended as a first-line, non-invasive treatment of SVT.…”

“…The VM provides better results than other vagal manoeuvres (such as the carotid sinus massage or facial immersion),1 and hence it is usually recommended as a first-line, non-invasive treatment of SVT. However, some studies have shown that the standard VM rarely leads to a successful cardioversion (<20%) 3 4.…”

Practice patterns of cardiologists, general practitioners, and internists for managing supraventricular tachycardias in Greece

“…GPs and internists, however, in a significant proportion (22%) would skip vagal maneuvers and would administer an antiarrhythmic agent for SVT termination. It has been reported that only a few doctors instruct their patients to perform correctly the valsalva maneuver [5,6]. In case vagal maneuvers fail to restore sinus rhythm, an antiarrhythmic agent should be administered.…”