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

BACKGROUND: The Valsalva manoeuvre (VM) is used in the prehospital setting as a first-line treatment for managing haemodynamically stable supraventricular tachycardia (SVT) in the form of atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT). The hospital-based use of this technique is supported by a number of published studies, but the performance and efficacy of the VM in the prehospital setting has not been examined.
METHODS: A review of the literature via electronic databases was conducted. Six clinical studies examining the technique and efficacy of the VM in arrhythmia reversion were identified. No prehospital studies were identified. Significant variation in the practical application of the VM and its efficacy was noted.
RESULTS: The literature identified three primary elements of the technique which affected its efficacy in reversion of SVT: a pressure of 40 mm Hg, the supine position and duration of 15 s. The efficacy of the VM in reversion of SVT is difficult to quantify in some literature owing to variations in technique and clinical application. The VM appears to be more successful than carotid sinus massage and ice-to-face techniques, and is inherently safe across all age groups.
CONCLUSION: 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.