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Single Syringe Adenosine for SVT

December 2, 2019

Written by Clay Smith

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Giving adenosine 6mg in 20mL of saline as a single syringe push vs the usual 6mg push and rapid flush with 20mL saline was non-inferior for the treatment of SVT.

Why does the matter?
One of the challenges of giving adenosine is pushing and rapidly flushing it, given its ultrashort half life. Might giving it diluted in one syringe – a sort of push and flush together – work as well? This was first popularized on FOAM by ALiEM.

Don’t be alarmed when your heart stops
This was a non-blinded prospective study in which clinicians could choose a single-syringe (SS) (n = 26) or two-syringe (TS) with stopcock (n = 27) method of giving adenosine. They started with either 6mg in 18mL (total 20mL) of NS or 6mg and a 20mL flush via two-way stopcock. They thought the SS method would be at least 80% as effective as the TS method and set the non-inferiority margin at 20%. For the primary outcome of conversion to NSR with one dose, the SS group was non-inferior to the TS group; 73.1% (95%CI 0.55 to 0.91) to 40.7% (95%CI 0.21 to 0.61; noninferiority, p = 0.0176). There was one extravasation event in the TS group and none in the SS group. Of note, this was a small unblinded pilot study. However, it showed non-inferiority with the SS technique. I think I will try this with my next SVT patient.

Single Syringe Administration of Diluted Adenosine. Acad Emerg Med. 2019 Oct 30. doi: 10.1111/acem.13879. [Epub ahead of print]

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