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Maniobra de vasalva modificada para el tratamiento de la taquicardia supraventricular

Tema en 'Soporte Vital Avanzado Cardiológico. RCP avanzada' comenzado por elenuskienf, 13 Sep 2015.

  1. elenuskienf

    elenuskienf e-mergencista experimentado

    FUENTE: The Lancet.

    Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial

    Summary
    Background
    The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5–20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. We assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness.



    Methods
    We did a randomised controlled, parallel-group trial at emergency departments in England. We randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fibrillation and flutter) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain), or a standard semi-recumbent Valsalva manoeuvre. A 40 mm Hg pressure, 15 s standardised strain was used in both groups. Randomisation, stratified by centre, was done centrally and independently, with allocation with serially numbered, opaque, sealed, tamper-evident envelopes. Patients and treating clinicians were not masked to allocation. The primary outcome was return to sinus rhythm at 1 min after intervention, determined by the treating clinician and electrocardiogram and confirmed by an investigator masked to treatment allocation. This study is registered with Current Controlled Trials (ISRCTN67937027).

    Findings
    We enrolled 433 participants between Jan 11, 2013, and Dec 29, 2014. Excluding second attendance by five participants, 214 participants in each group were included in the intention-to-treat analysis. 37 (17%) of 214 participants assigned to standard Valsalva manoeuvre achieved sinus rhythm compared with 93 (43%) of 214 in the modified Valsalva manoeuvre group (adjusted odds ratio 3·7 (95% CI 2·3–5·8; p<0·0001). We recorded no serious adverse events.

    Interpretation
    In patients with supraventricular tachycardia, a modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain should be considered as a routine first treatment, and can be taught to patients.

    Pequeña traducción y vídeo en mi blog: http://urgenciasyemergen.blogspot.com.es/2015/09/maniobra-de-vasalva-modificada-para-el.html
    Un saludo.
     
    Última modificación: 13 Sep 2015
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  2. Jamie

    Jamie e-mergencista experimentado

    Respuesta: Maniobra de vasalva modificada para el tratamiento de la taquicardia supra

    Muy interesante
     
  3. Jamie

    Jamie e-mergencista experimentado

    Lo probamos hace unos días, no funcionó.
     
  4. Elier CG

    Elier CG Super Moderator Miembro del Equipo

    Entonces que hago, le subo los pies mientras masajeo y los bajo inmediatamente que termine,...no he podido ver el video, no me da acceso desde mi conexión. podrías en principio Elena explicarlo.
     
  5. Elier CG

    Elier CG Super Moderator Miembro del Equipo

    La he probado y al menos en pocos casos, con 100 % efectividad.

    Debimos que especificar a los paciente ( habituales en padecer la arritmia) que no pusieran en práctica en casa. por si acaso. Ja,ja
     

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