Prehospital diagnosis and management of supraventricular tachycardia – a scoping review

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BACKGROUND: Supraventricular tachycardias (SVTs) are tachyarrhythmias that may result in haemodynamic instability and require prompt recognition and management in the prehospital setting. Current guidelines recommend a stepwise approach- vagal manoeuvres, adenosine, and electrical cardioversion (ECV) for unstable or refractory cases. However, prehospital care is characterized by diagnostic uncertainty, limited resources, and variable provider expertise and evidence specifically addressing prehospital care of SVT remains fragmented. This scoping review aimed to map the existing literature and identify key knowledge gaps. METHODS: This review was conducted following Joanna Briggs Institute methodology and reported according to PRISMAScR; the protocol was registered on the Open Science Framework. Eligibility and data charting adopted the Population-Concept-Context framework. Population included prehospital SVT patients and emergency medical services (EMS) personnel. Concepts covered diagnostic accuracy, treatment strategies, efficacy, safety, telemedicine, logistics, and provider confidence. Context included EMS systems provided by paramedics, nurses, or physicians. Only English-language studies reporting at least one of the predefined concepts were included. Multiple databases were searched from inception to July 2025. Two independent reviewers screened studies and extracted data, with discrepancies resolved by consensus. Only Valsalva Manoeuvre (VM), adenosine and ECV were reported in results. RESULTS: Thirty studies (17,704 patients; 1987-2025), mainly from North America and Europe, were included. Diagnostic accuracy ranged from 54.5% to 98.0% and telemedicine was adopted in 27% of studies. VM efficacy varied from 6 to 43%, with few adverse events reported, and the modified version showing a higher success rate. Adenosine achieved 48% to 100% efficacy, with mild side effects and rare fatal episodes typically due to misdiagnosis. ECV exceeded 80% success but had limited safety data. Treat-and-release pathways safely discharged up to 54% of patients in two studies. CONCLUSION: Despite substantial heterogeneity in the available literature on prehospital SVT, evidence suggests that diagnostic accuracy may affect both treatment efficacy and safety, highlighting the need for advances in this area. The adoption of modified VM as an initial treatment strategy may decrease unnecessary exposure to potentially higher-risk drugs and procedures. Treat-and-release protocols appear safe in selected patients and may help reduce emergency department admissions and associated healthcare costs.

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