Effectiveness and Safety of Paramedic Administration of Verapamil and Adenosine for the Treatment of Supraventricular Tachycardia: A Review of the Literature

Introduction Adenosine and verapamil are the most commonly used pharmacological agents to treat supraventricular tachycardia (SVT). This review aims to identify the effectiveness and safety of pre-hospital use of adenosine and verapamil by paramedics. Methods A comprehensive electronic literature search was conducted. Studies of pre-hospital comparative effectiveness of adenosine and verapamil were included for further analysis. Studies where individual effectiveness of either verapamil or adenosine was reported in either the medical or pre-hospital setting were excluded. Animal studies and those articles unavailable in English were also excluded. Results Two pre-hospital studies were identified. Verapamil demonstrated greater reversion effectiveness across both studies, with side effects more commonly reported in the adenosine arm of each. The duration and severity of side effects resulting from verapamil administration was greater than that of adenosine. Paramedic electrocardiogram (ECG) interpretation was questionable, resulting in a number of errors across both studies. Conclusion Available studies report that verapamil is more effective for pre-hospital SVT reversion. Effective pre-hospital drug therapy for SVT must incorporate a measure of patient impact with regard to severity, duration and interventions required to correcting adverse effects. A larger contemporary study is required to further evidence paramedic use of pharmacological agents to treat SVT. Paramedic ECG interpretation is a key factor influencing correct treatment, and adequate education must form the basis of pre-hospital guidelines for SVT management.