Use and effectiveness of the Valsalva maneuver for supraventricular tachycardia in prehospital emergency care: a retrospective cohort study

Vagal maneuvers are recommended as first-line therapy for hemodynamically stable supraventricular tachycardia (SVT). However, real-world data on their use in prehospital emergency medical services (EMS) remain limited. To evaluate the utilization and effectiveness of the Valsalva maneuver in the prehospital management of tachyarrhythmia, with particular focus on patients with confirmed SVT. A retrospective cohort study was conducted using EMS documentation from a regional EMS system in Poland between 2023 and 2024. Among 93,847 EMS interventions, 235 cases coded as unspecified tachycardia (ICD-10 R00.0) were identified. Data included patient demographics, ECG findings, syncope, performance and outcome of the Valsalva maneuver, and hospital transport decisions. Subgroup analysis focused on patients with ECG-confirmed SVT. SVT was documented in 71 patients (30.2%). The Valsalva maneuver was performed in 13 patients (5.5% of the cohort) and in 18.3% of those with confirmed SVT. Sustained conversion to sinus rhythm occurred in 5 of 13 patients (38.5%; 95% CI 13.9–68.4%), with transient improvement in one additional case. All attempts were performed in patients with narrow-complex tachycardia consistent with SVT. Hospital transport occurred in most patients regardless of maneuver performance or outcome. In this EMS cohort, the Valsalva maneuver was infrequently used despite guideline recommendations. When performed, rhythm conversion occurred in a minority of cases and did not substantially influence transport decisions. These findings highlight the gap between guideline recommendations and real-world prehospital practice.