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

Honarbakhsh, Shohreh; Baker, Victoria; Kirkby, Claire; Patel, Kapil; Robinson, G. Canby; Antoniou, Sotiris; Richmond, Laura; Ullah, Waqas; Hunter, Ross J.; Finlay, Malcolm; Earley, Mark J.; Whitbread, Mark; Schilling, Richard J.

doi:10.1136/heartjnl-2016-309968

Cited by 10 publications

(10 citation statements)

References 9 publications

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“…[27] Honarbakhsh et al in a randomized controlled trial revealed that there was a 98% correlation between the paramedics’ ECG diagnosis of supraventricular tachycardia and that of 2 electrophysiologists. [28] ECG interpretation skills were also examined among Polish EMS providers. The results of the Competition in Medical Rescue Krakow 2014, which consisted of interpretation of 5 different records depicting STEMI, atrial fibrillation, supraventricular tachycardia, third degree atrioventricular block were later analyzed.…”

Section: Discussionmentioning

confidence: 99%

ECG pre-hospital teletransmission by emergency teams staffed with an emergency physician and paramedics and its impact on transportation and hospital admission

et al. 2019

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Electrocardiography (ECG) is essential to detect and diagnose life threatening cardiac conditions and to determine further treatment. Correct interpretation of an ECG can be challenging, especially in the out-of-hospital setting and by less experienced emergency team members. The aim of this study was to compare the rate of ECG transmission from an out-of-hospital emergency scene to an in-hospital cardiologist on call in EMS-B and EMS-S providers and its impact on direct transportation to a cardiac catheterization laboratory and hospital admission. The study was designed as an observational study. Data from 3 separate emergency medical service teams were collected. Two teams are staffed by paramedics only (EMT-B), while another specialized team is staffed with an emergency physician (EMT-S). 5864 out-of-hospital emergencies were performed during a 12-month period and were analyzed for this study. In 124 out of 5864 (2.1%) out-of-hospital emergencies, an ECG transmission from the out-of-hospital scene to an in-hospital cardiologist on call was performed. Rate of transmission was similar between both teams (EMT-B n = 70, 2.2% vs EMT-S n = 54, 2.0%, P = .054). After coordinating with the cardiologist on call, 11 patients (15.7%) of the EMT-B (15.7%) and 24 patients (44.4%) of the EMT-S were directly transported from the scene of emergency to a cardiac catheterization laboratory ( P < .001). Overall, 80% of patients treated by EMT-S, compared to 52.5% treated by the EMT-B required subsequent hospital admission ( P < .05). Transmission of ECG from the out-of-hospital emergency scene to the in-hospital cardiologist is infrequently performed. The rate of STEMI in transmitted ECG's by emergency teams staffed with an emergency physician was higher compared to emergency teams staffed with paramedics only.

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Section: Discussionmentioning

confidence: 99%

ECG pre-hospital teletransmission by emergency teams staffed with an emergency physician and paramedics and its impact on transportation and hospital admission

et al. 2019

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“…The current ERC guidelines [6] recommend the treatment in narrow and broad complex tachycardia in stable and unstable patients. SVT is a common cause of acute hospital presentations [7].…”

Section: Discussionmentioning

confidence: 99%

“…Honarbakhsh et al [7] compared paramedicwith the hospital-delivered treatment of acute SVT with adenosine. They revealed that patients with SVT could be effectively and safely treated by paramedics with the use of adenosine.…”

Section: Discussionmentioning

confidence: 99%

Knowledge of and attitudes to emergency tachyarrhythmia treatment among paramedics and nurses

Sokołowski

Wawrzyńska

2019

Disaster Emerg Med J

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IntroductIon: Supraventricular tachycardia (SVT) is a wide term used to describe tachycardia with atrial and/or ventricular rates exceeding 100 bpm at rest. The underlying mechanism involves His bundle or tissue lying above. As the diagnosis of SVT is often made in the prehospital settings or in an emergency department, the relevant knowledge of all medical personnel, including paramedics, on the diagnosis and treatment procedures is crucial for the patient's outcome. It is essential to quickly assess the patient's clinical condition and make decisions based on both electrocardiographic records and the occurrence of adverse symptoms. Some procedures and pharmacological treatments can be implemented by the paramedic on their own, some require a physician's supervision. The aim of the study was to assess paramedics' and nurses' knowledge concerning emergency management in tachycardia. MethodS: The study was conducted in January 2019 in southwestern Poland among paramedics and nurses working in the Polish National Emergency Medical System (EMS). All participants received information on the study objectives and voluntarily took part in the questionnaire survey. The questionnaire was developed by the authors and included 22 questions referring to gender, age, work experience, type of work in EMS, number of inhabitants in the workplace area, latest training in advanced life support, adverse events in hemodynamically unstable patients, vagal manoeuvres, European Resuscitation Council 2015 guidelines for narrow and broad complex tachycardia in stable and unstable patients with regular and irregular rhythms, indications for synchronized electrical cardioversion, performing synchronized electrical cardioversion in the past, concerns about cardioversion and self-assessed level of experience in tachyarrhythmia treatment.

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“…Attempts to reduce the burden of SVTs on emergency departments have included examining paramedic-led adenosine administration in the community when the patient has a narrow complex tachycardia without a history of structural or ischaemic heart disease. [ 52 ] Successful adenosine cardioversion at the scene of presentation allows immediate discharge of certain patients with follow-up arranged by the primary care physician. In this study, 81% of adenosine-treated patients cardioverted to sinus rhythm and 77% of these could be directly discharged, accounting for more than half of the patients treated.…”

Section: Electrophysiological Effects Of Adenosinementioning

confidence: 99%

Unmasking Adenosine: The Purinergic Signalling Molecule Critical to Arrhythmia Pathophysiology and Management

Matthews

Grace

2020

Arrhythm Electrophysiol Rev

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Adenosine was identified in 1929 and immediately recognised as having a potential role in therapy for arrhythmia because of its negative chronotropic and dromotropic effects. Adenosine entered mainstream use in the 1980s as a highly effective agent for the termination of supraventricular tachycardia (SVT) involving the atrioventricular node, as well as for its ability to unmask the underlying rhythm in other SVTs. Adenosine has subsequently been found to have applications in interventional electrophysiology. While considered a safe agent because of its short half-life, adenosine may provoke arrhythmias in the form of AF, bradyarrhythmia and ventricular tachyarrhythmia. Adenosine is also associated with bronchospasm, although this may reflect irritant-induced dyspnoea rather than true obstruction. Adenosine is linked to numerous pathologies relevant to arrhythmia predisposition, including heart failure, obesity, ischaemia and the ageing process itself. This article examines 90 years of experience with adenosine in the light of new European Society of Cardiology guidelines for the management of SVT.

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

Abstract: NCT02216240.

Cited by 10 publications

References 9 publications

ECG pre-hospital teletransmission by emergency teams staffed with an emergency physician and paramedics and its impact on transportation and hospital admission

ECG pre-hospital teletransmission by emergency teams staffed with an emergency physician and paramedics and its impact on transportation and hospital admission

Knowledge of and attitudes to emergency tachyarrhythmia treatment among paramedics and nurses

Unmasking Adenosine: The Purinergic Signalling Molecule Critical to Arrhythmia Pathophysiology and Management

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