Safety and efficacy of paramedic treatment of regular supraventricular tachycardia: a randomised controlled trial
Honarbakhsh, S. Baker, Victoria Kirkby, C. Patel, K. Robinson, G. Antoniou, Sotiris Richmond, L. Ullah, W. Hunter, R.J. Finlay, M.
Honarbakhsh, S.
Baker, Victoria
Kirkby, C.
Patel, K.
Robinson, G.
Antoniou, Sotiris
Richmond, L.
Ullah, W.
Hunter, R.J.
Finlay, M.
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Abstract
Introduction Supraventricular tachycardias (SVTs) are a
common cause of acute hospital presentations. Adenosine
is an effective treatment. To date, no studies have directly
compared paramedic-with hospital-delivered treatment of
acute SVT with adenosine.
Method Randomised controlled trial comparing the
treatment of SVT and discharge by paramedics with
conventional emergency department (ED)-based care.
Patients were excluded if they had structural heart disease
or contraindication to adenosine. Discharge time, follow-up
management, costs and patient satisfaction were
compared.
Results Eighty-six patients were enrolled: 44 were
randomised to paramedic-delivered adenosine (PARA) and
42 to conventional care (ED). Of the 37 patients in the
PARA group given adenosine, the tachycardia was
successfully terminated in 81%. There was a 98%
correlation between the paramedics’ ECG diagnosis and
that of two electrophysiologists. No patients had any
documented adverse events in either group. The discharge
time was lower in the PARA group than in the ED group
(125 min (range 55–9513) vs 222 min (range 72–
26 153); p=0.01), and this treatment strategy was more
cost-effective (£282 vs £423; p=0.01). The majority of
patients preferred this management approach. Being
treated and discharged by paramedics did not result in the
patients being less likely to receive ongoing management
of their arrhythmia and cardiology follow-up.
Conclusions Patients with SVT can effectively and safely
be treated with adenosine delivered by trained paramedics.
Implementation of paramedic-delivered acute SVT care has
the potential to reduce healthcare costs without
compromising patient care.
https://heart.bmj.com/content/heartjnl/103/18/1413.full.pdf
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http://dx.doi.org/10.1136/heartjnl-2016-309968