Abstract
Background
The prehospital use of adenosine in the treatment of supraventricular arrhythmias has recently been implemented in standard ambulance care. However, establishing the origin and nature of the arrhythmia with certainty is an absolute requirement for using adenosine.
Methods
The ability of the ambulance nurse to predict supraventricular arrhythmias and the necessity of prehospital treatment of arrhythmias in general was evaluated. To do this, cardiologists at the Academic Medical Centre of Amsterdam were consulted and a literature search by means of an electronic search in Pubmed was performed. The search was complemented by a second survey concerning antagonists of adenosine using the keywords: adenosine and theophylline. Moreover, the Ambulance Nurse textbook, the National Protocol for Ambulance Care as well as the explanatory memorandum to the protocol were consulted.
Results
No strong indication for the prehospital use of adenosine was found, while detrimental effects of the drug can occur. There is no literature showing the ability of ambulance staff to correctly interpret complex cardiac arrhythmias in the Netherlands; the current ambulance protocol does not prevent an incorrect choice of therapy and medication.
Conclusion
It is strongly advised against using antiarrhythmic medication for the treatment of tachycardias in a prehospital setting if this treatment can be postponed to the hospital environment.
Keywords: arrhythmia, adenosine, prehospital
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Belhassen B., Viskin S. What is the drug of choice for the acute termination of paroxysmal supraventricular tachycardia: verapamil, adenosine triphosphate, or adenosine? Pacing Clin Electrophysiol. 1993 Aug;16(8):1735–1741. doi: 10.1111/j.1540-8159.1993.tb01044.x. [DOI] [PubMed] [Google Scholar]
- Camm A. J., Garratt C. J. Adenosine and supraventricular tachycardia. N Engl J Med. 1991 Dec 5;325(23):1621–1629. doi: 10.1056/NEJM199112053252306. [DOI] [PubMed] [Google Scholar]
- De Lorenzo R. A. Prehospital misidentification of tachydysrhythmias: a report of five cases. J Emerg Med. 1993 Jul-Aug;11(4):431–436. doi: 10.1016/0736-4679(93)90246-4. [DOI] [PubMed] [Google Scholar]
- DiMarco J. P., Miles W., Akhtar M., Milstein S., Sharma A. D., Platia E., McGovern B., Scheinman M. M., Govier W. C. Adenosine for paroxysmal supraventricular tachycardia: dose ranging and comparison with verapamil. Assessment in placebo-controlled, multicenter trials. The Adenosine for PSVT Study Group. Ann Intern Med. 1990 Jul 15;113(2):104–110. doi: 10.7326/0003-4819-113-2-104. [DOI] [PubMed] [Google Scholar]
- Domanovits H., Laske H., Stark G., Sterz F., Schmidinger H., Schreiber W., Müllner M., Laggner A. N. Adenosine for the management of patients with tachycardias--a new protocol. Eur Heart J. 1994 May;15(5):589–593. doi: 10.1093/oxfordjournals.eurheartj.a060553. [DOI] [PubMed] [Google Scholar]
- Gausche M., Persse D. E., Sugarman T., Shea S. R., Palmer G. L., Lewis R. J., Brueske P. J., Mahadevan S., Melio F. R., Kuwate J. H. Adenosine for the prehospital treatment of paroxysmal supraventricular tachycardia. Ann Emerg Med. 1994 Aug;24(2):183–189. doi: 10.1016/s0196-0644(94)70128-8. [DOI] [PubMed] [Google Scholar]
- Hood M. A., Smith W. M. Adenosine versus verapamil in the treatment of supraventricular tachycardia: a randomized double-crossover trial. Am Heart J. 1992 Jun;123(6):1543–1549. doi: 10.1016/0002-8703(92)90807-8. [DOI] [PubMed] [Google Scholar]
- Lozano M., Jr, McIntosh B. A., Giordano L. M. Effect of adenosine on the management of supraventricular tachycardia by urban paramedics. Ann Emerg Med. 1995 Dec;26(6):691–696. doi: 10.1016/s0196-0644(95)70039-0. [DOI] [PubMed] [Google Scholar]
- Mader T. J., Bertolet B., Ornato J. P., Gutterman J. M. Aminophylline in the treatment of atropine-resistant bradyasystole. Resuscitation. 2000 Oct;47(2):105–112. doi: 10.1016/s0300-9572(00)00234-3. [DOI] [PubMed] [Google Scholar]
- Madsen C. D., Pointer J. E., Lynch T. G. A comparison of adenosine and verapamil for the treatment of supraventricular tachycardia in the prehospital setting. Ann Emerg Med. 1995 May;25(5):649–655. doi: 10.1016/s0196-0644(95)70179-6. [DOI] [PubMed] [Google Scholar]
- McCabe J. L., Adhar G. C., Menegazzi J. J., Paris P. M. Intravenous adenosine in the prehospital treatment of paroxysmal supraventricular tachycardia. Ann Emerg Med. 1992 Apr;21(4):358–361. doi: 10.1016/s0196-0644(05)82650-2. [DOI] [PubMed] [Google Scholar]
- Rankin A. C., Brooks R., Ruskin J. N., McGovern B. A. Adenosine and the treatment of supraventricular tachycardia. Am J Med. 1992 Jun;92(6):655–664. doi: 10.1016/0002-9343(92)90784-9. [DOI] [PubMed] [Google Scholar]
- Rankin A. C., Oldroyd K. G., Chong E., Dow J. W., Rae A. P., Cobbe S. M. Adenosine or adenosine triphosphate for supraventricular tachycardias? Comparative double-blind randomized study in patients with spontaneous or inducible arrhythmias. Am Heart J. 1990 Feb;119(2 Pt 1):316–323. doi: 10.1016/s0002-8703(05)80022-5. [DOI] [PubMed] [Google Scholar]
- Strickberger S. A., Man K. C., Daoud E. G., Goyal R., Brinkman K., Knight B. P., Weiss R., Bahu M., Morady F. Adenosine-induced atrial arrhythmia: a prospective analysis. Ann Intern Med. 1997 Sep 15;127(6):417–422. doi: 10.7326/0003-4819-127-6-199709150-00001. [DOI] [PubMed] [Google Scholar]
- Tan H. L., Spekhorst H. H., Peters R. J., Wilde A. A. Adenosine induced ventricular arrhythmias in the emergency room. Pacing Clin Electrophysiol. 2001 Apr;24(4 Pt 1):450–455. doi: 10.1046/j.1460-9592.2001.00450.x. [DOI] [PubMed] [Google Scholar]
- Wittwer L. K., Muhr M. D. Adenosine for the treatment of PSVT in the prehospital arena: efficacy of an initial 6 mg dosing regimen. Prehosp Disaster Med. 1997 Jul-Sep;12(3):237–239. [PubMed] [Google Scholar]