Knowledge of and attitudes to emergency tachyarrhythmia treatment among paramedics and nurses

Abstract

INTRODUCTION: Supraventricular tachycardia (SVT) is a wide term used to describe tachycardia with atri- al and/or ventricular rates exceeding 100 bpm at rest. The underlying mechanism involves His bundle or tissue lying above. As the diagnosis of SVT is often made in the prehospital settings or in an emergency department, the relevant knowledge of all medical personnel, including paramedics, on the diagnosis and treatment procedures is crucial for the patient’s outcome. It is essential to quickly assess the patient’s clinical condition and make decisions based on both electrocardiographic records and the occurrence of adverse symptoms. Some procedures and pharmacological treatments can be implemented by the paramedic on their own, some require a physician’s supervision. The aim of the study was to assess paramedics’ and nurs- es’ knowledge concerning emergency management in tachycardia.

METHODS: The study was conducted in January 2019 in south-western Poland among paramedics and nurses working in the Polish National Emergency Medical System (EMS). All participants received information on the study objectives and voluntarily took part in the questionnaire survey. The questionnaire was developed by the authors and included 22 questions referring to gender, age, work experience, type of work in EMS, number of inhabitants in the workplace area, latest training in advanced life support, adverse events in hemodynamically unstable patients, vagal manoeuvres, European Resuscitation Council 2015 guidelines for narrow and broad complex tachycardia in stable and unstable patients with regular and irregular rhythms, indications for synchronized electrical cardioversion, performing synchronized electrical cardioversion in the past, concerns about cardioversion and self-assessed level of experience in tachyarrhythmia treatment.

RESULTS: Overall, 200 paramedics and 50 nurses were asked to participate in the study. The final question- naire return rate was 84.5%. The mean age of the participants equalled as 37.90 ± 11.44 years; 50 (29.59%) were female; the mean work experience was 12.07 ± 10.39 years. The correct treatment in a stable patient with narrow QRS tachyarrhythmia (including vassal manoeuvres and adenosine administration) was pro- posed by 88.17% of the participants. The correct treatment in an unstable patient with broad QRS tachyar- rhythmia was proposed by 84.60% of the participants. Overall, 56.80% indicated correct treatment with a beta-blocker in a stable patient with irregular narrow complex tachyarrhythmia with a duration of over 48 hours; 87.57% knew the role of magnesium sulphate in torsade de pointes treatment. Only 34.91% had conducted electrical cardioversion in the past. According to the subjects, the main problems associated with the procedure of electrical cardioversion were: analgosedation and airway management (52.66%), the risk for sudden cardiac arrest as a result of electrical cardioversion (53.25%), and the risk of a stroke (38.46%). The proper number of electrical cardioversions in unstable patients was proposed by 73.37% of the partic- ipants; 66.86% knew the correct dose of amiodarone when the correct electrical cardioversion sequence does not restore the sinus rhythm and the patient remains unstable. Only 43.79% knew the correct initial biphasic energy for electrical cardioversion in unstable broad complex tachyarrhythmia (120–150 J), while most responders indicated energy up to 120 J. The mean self-assessed level of experience in tachyarrhythmia treatment was 6.00 ± 1.76 in a scale of 0–10, where 0 meant lack of experience and 10 stood for experience ensuring proper performance of the procedure.

CONCLUSIONS: The knowledge of Polish paramedics and nurses concerning the emergency treatment of tach- yarrhythmia is unsatisfactory in many aspects. Better undergraduate and postgraduate training on advanced life support guidelines should be recommended.