Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial
Introduction Patients with episodes of supraventricular tachycardia (SVT), a common heart arrhythmia, are often attended by ambulance services. International guidelines advocate treatment with the Valsalva manoeuvre (VM), but this simple physical treatment has a low success rate, with most patients...
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/6/e073315.full |
| _version_ | 1797808349034577920 |
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| author | Andrew Appelboam Sarah Black Victoria Jones James King Mark Dayer Peter Chapman Helen Harris Andy Cole Ben Jones Obioha Ukoumunne Neil Armstrong Mike Smith Annie Hawton Emma Cockcroft Siobhan Creanor Lucy Davies Matthew Adams Nicholas Richards Shelley Rhodes David Willis Martyn Morris Adam Hill Harry Brown Mark Reilly William Price Annette Gillett Phoebe Dawe Alison Coppola Ria Osborne Natalie Scotney Suzanne Boot Tim Cranston Ruth Hawker Michela Cox Beccy Summers Yunli Ou Leanne Bessell Ludwig Holzer Ross Clarkson Charlotte Macey-Woolmer Leigh Simpkins Sarah-Jane Hill Andy Waring Will Kivell Alice Foxen Samuel Withams Jade Barber Tarin Payne Thomas Boyling Kristin Houlgate Dane O'Reilly Jamie Sprake Dylan Evans Daniel Titcombe Gemma Abbott Peter Caine Ben Astley Vince McKenzie-Plume Jim Burn Ashley Ingram Paula Long Joe Phipps Lewis Hare Kirsty Walker Charlotte Copley James Keat Craig Chedzoy Leah Mason Rich Godfrey Dale Jefferies Nicole Morrison Kirsty Carpenter Steve Palmer Tara Marchant Sabrina Bolwell Tracy Hoad Stuart Stimson Collette Young Oscar Miller Joe Meering Ashley Watson Katharine Laurenson Lee Clarke John Carrielies Sharon Bowyer Adam Blinman Anna McCann Carrie-Anne Durrant Charlotte Blow Chris Taplin Marcus Goodwin Damon Godfrey Maree Holmes Rhys Allsopp Peter Willows Katrina Scott Sonia Wright-Stainton Stacey Lawrence Jacquiline Mullarney Lewis Garrood Tom Rutherford Luke Slocombe Alan Piper Julia Ryder Tom Driver Hannah Barber Joe Cartwright Loxley Patterson Chris Birch Kelly Chappell James Constable Naomi Miller Tara Rodda Tim Taylor Jason Trudgill Russell Hoskin Julie Legg Toni Howell Fergus Beeley Zoe Flowerdew Gary Rooney Cassandra Day Tamara Hoare Dylan Carey Lewis Murphy |
| author_facet | Andrew Appelboam Sarah Black Victoria Jones James King Mark Dayer Peter Chapman Helen Harris Andy Cole Ben Jones Obioha Ukoumunne Neil Armstrong Mike Smith Annie Hawton Emma Cockcroft Siobhan Creanor Lucy Davies Matthew Adams Nicholas Richards Shelley Rhodes David Willis Martyn Morris Adam Hill Harry Brown Mark Reilly William Price Annette Gillett Phoebe Dawe Alison Coppola Ria Osborne Natalie Scotney Suzanne Boot Tim Cranston Ruth Hawker Michela Cox Beccy Summers Yunli Ou Leanne Bessell Ludwig Holzer Ross Clarkson Charlotte Macey-Woolmer Leigh Simpkins Sarah-Jane Hill Andy Waring Will Kivell Alice Foxen Samuel Withams Jade Barber Tarin Payne Thomas Boyling Kristin Houlgate Dane O'Reilly Jamie Sprake Dylan Evans Daniel Titcombe Gemma Abbott Peter Caine Ben Astley Vince McKenzie-Plume Jim Burn Ashley Ingram Paula Long Joe Phipps Lewis Hare Kirsty Walker Charlotte Copley James Keat Craig Chedzoy Leah Mason Rich Godfrey Dale Jefferies Nicole Morrison Kirsty Carpenter Steve Palmer Tara Marchant Sabrina Bolwell Tracy Hoad Stuart Stimson Collette Young Oscar Miller Joe Meering Ashley Watson Katharine Laurenson Lee Clarke John Carrielies Sharon Bowyer Adam Blinman Anna McCann Carrie-Anne Durrant Charlotte Blow Chris Taplin Marcus Goodwin Damon Godfrey Maree Holmes Rhys Allsopp Peter Willows Katrina Scott Sonia Wright-Stainton Stacey Lawrence Jacquiline Mullarney Lewis Garrood Tom Rutherford Luke Slocombe Alan Piper Julia Ryder Tom Driver Hannah Barber Joe Cartwright Loxley Patterson Chris Birch Kelly Chappell James Constable Naomi Miller Tara Rodda Tim Taylor Jason Trudgill Russell Hoskin Julie Legg Toni Howell Fergus Beeley Zoe Flowerdew Gary Rooney Cassandra Day Tamara Hoare Dylan Carey Lewis Murphy |
| collection | DOAJ |
| description | Introduction Patients with episodes of supraventricular tachycardia (SVT), a common heart arrhythmia, are often attended by ambulance services. International guidelines advocate treatment with the Valsalva manoeuvre (VM), but this simple physical treatment has a low success rate, with most patients requiring conveyance to hospital. The Valsalva Assist Device (VAD) is a simple device that might help practitioners and patients perform a more effective VM and reduce the need for patients to be taken to hospital.Methods and analysis This stepped wedge cluster randomised controlled trial, conducted within a UK ambulance service, compares the current standard VM with a VAD-delivered VM in stable adult patients presenting to the ambulance service with SVT. The primary outcome is conveyance to hospital; secondary outcomes measures include cardioversion rates, duration of ambulance care and number of subsequent episodes of SVT requiring ambulance service care. We plan to recruit approximately 800 patients, to have 90% power to detect an absolute reduction in conveyance rate of 10% (from 90% to 80%) between the standard VM (control) and VAD-delivered VM (intervention). Such a reduction in conveyance would benefit patients, the ambulance service and receiving emergency departments. It is estimated potential savings would pay for devices for the entire ambulance trust within 7 months.Ethics and dissemination The study has been approved by the Oxford Research Ethics Committee (reference 22/SC/0032). Dissemination will be through peer-reviewed journal publication, presentation at national and international conferences and by the Arrhythmia Alliance, a patient support charity.Trial registration number ISRCTN16145266. |
| first_indexed | 2024-03-13T06:36:13Z |
| format | Article |
| id | doaj.art-9ba077145f604b38a7cc822cb0276100 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-13T06:36:13Z |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-9ba077145f604b38a7cc822cb02761002023-06-09T04:30:06ZengBMJ Publishing GroupBMJ Open2044-60552023-06-0113610.1136/bmjopen-2023-073315Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial 0Andrew Appelboam1Sarah Black2Victoria Jones3James King4Mark Dayer5Peter Chapman6Helen Harris7Andy Cole8Ben Jones9Obioha Ukoumunne10Neil Armstrong11Mike SmithAnnie Hawton12Emma Cockcroft13Siobhan Creanor14Lucy Davies15Matthew Adams16Nicholas Richards17Shelley Rhodes18David Willis19Martyn MorrisAdam Hill20Harry Brown21Mark Reilly22William PriceAnnette Gillett23Phoebe DaweAlison Coppola24Ria Osborne25Natalie Scotney26Suzanne Boot27Tim Cranston28Ruth Hawker29Michela CoxBeccy SummersYunli OuLeanne BessellLudwig HolzerRoss ClarksonCharlotte Macey-WoolmerLeigh SimpkinsSarah-Jane HillAndy WaringWill KivellAlice FoxenSamuel WithamsJade BarberTarin PayneThomas BoylingKristin HoulgateDane O'ReillyJamie SprakeDylan EvansDaniel TitcombeGemma AbbottPeter CaineBen AstleyVince McKenzie-PlumeJim BurnAshley IngramPaula LongJoe PhippsLewis HareKirsty WalkerCharlotte CopleyJames KeatCraig ChedzoyLeah MasonRich GodfreyDale JefferiesNicole MorrisonKirsty CarpenterSteve PalmerTara MarchantSabrina BolwellTracy HoadStuart StimsonCollette YoungOscar MillerJoe MeeringAshley WatsonKatharine LaurensonLee ClarkeJohn CarrieliesSharon BowyerAdam BlinmanAnna McCannCarrie-Anne DurrantCharlotte BlowChris TaplinMarcus GoodwinDamon GodfreyMaree HolmesRhys AllsoppPeter WillowsKatrina ScottSonia Wright-StaintonStacey LawrenceJacquiline MullarneyLewis GarroodTom RutherfordLuke SlocombeAlan PiperJulia RyderTom DriverHannah BarberJoe CartwrightLoxley PattersonChris BirchKelly ChappellJames ConstableNaomi MillerTara RoddaTim TaylorJason TrudgillRussell HoskinJulie LeggToni HowellFergus BeeleyZoe FlowerdewGary RooneyCassandra DayTamara HoareDylan CareyLewis Murphy8 University of London, London, UKEmergency Department, Royal Devon and Exeter Foundation Trust, Exeter, UK5 Research and Audit, South Western Ambulance Service NHS Foundation Trust, Exeter, Devon, UKMolecular Pathology, Sullivan Nicolaides Pathology, Brisbane, QLD, Australia2University of Hertfordshire, UKDepartment of Cardiology, Taunton and Somerset HospitalDepartment of Radiology Hampshire Hospitals NHS Foundation Trust, Winchester, UK10 National Infection Service, Public Health England, London, UK3Leicester General Hospital, UKCarnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UKNIHR ARC South West Peninsula, University of Exeter, Exeter, UKChildren`s Health and Exercise Research Centre, University of Exeter, Exeter, Devon, UKHealth Economics Group, University of Exeter Medical School, University of Exeter, Exeter, UK1 NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK3 Medical Statistics Group, University of Plymouth, Plymouth, UKOperations Team, Royal National Orthopaedic Hospital Stanmore, Stanmore, UKLysholm Department of Neuroradiology, National Hospital for Neurology & Neurosurgery, London, UK1Academic Unit of Surgical Oncology, Department of Oncology, University of Sheffield, Sheffield, UKMedical School, University of Exeter, Exeter, UKKeystone Child, Youth, and Family Services, Owen Sound, Ontario, Canada3 Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UKKinesiology and Physical Education, McGill University, Montreal, Quebec, CanadaepidemiologistPeninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK1South Western Ambulance Service NHS Foundation Trust, UK1South Western Ambulance Service NHS Foundation Trust, UKResearch, Audit and Quality Improvement Department, South Western Ambulance Service NHS Foundation Trust, Exeter, UKSouth Western Ambulance Service NHS Foundation Trust, Exeter, UKExeter Clinical Trials Unit, University of Exeter Medical School, Exeter, UKPPI Representative, honorary SWASFT contract, South Western Ambulance Service NHS Foundation Trust, Exeter, UKIntroduction Patients with episodes of supraventricular tachycardia (SVT), a common heart arrhythmia, are often attended by ambulance services. International guidelines advocate treatment with the Valsalva manoeuvre (VM), but this simple physical treatment has a low success rate, with most patients requiring conveyance to hospital. The Valsalva Assist Device (VAD) is a simple device that might help practitioners and patients perform a more effective VM and reduce the need for patients to be taken to hospital.Methods and analysis This stepped wedge cluster randomised controlled trial, conducted within a UK ambulance service, compares the current standard VM with a VAD-delivered VM in stable adult patients presenting to the ambulance service with SVT. The primary outcome is conveyance to hospital; secondary outcomes measures include cardioversion rates, duration of ambulance care and number of subsequent episodes of SVT requiring ambulance service care. We plan to recruit approximately 800 patients, to have 90% power to detect an absolute reduction in conveyance rate of 10% (from 90% to 80%) between the standard VM (control) and VAD-delivered VM (intervention). Such a reduction in conveyance would benefit patients, the ambulance service and receiving emergency departments. It is estimated potential savings would pay for devices for the entire ambulance trust within 7 months.Ethics and dissemination The study has been approved by the Oxford Research Ethics Committee (reference 22/SC/0032). Dissemination will be through peer-reviewed journal publication, presentation at national and international conferences and by the Arrhythmia Alliance, a patient support charity.Trial registration number ISRCTN16145266.https://bmjopen.bmj.com/content/13/6/e073315.full |
| spellingShingle | Andrew Appelboam Sarah Black Victoria Jones James King Mark Dayer Peter Chapman Helen Harris Andy Cole Ben Jones Obioha Ukoumunne Neil Armstrong Mike Smith Annie Hawton Emma Cockcroft Siobhan Creanor Lucy Davies Matthew Adams Nicholas Richards Shelley Rhodes David Willis Martyn Morris Adam Hill Harry Brown Mark Reilly William Price Annette Gillett Phoebe Dawe Alison Coppola Ria Osborne Natalie Scotney Suzanne Boot Tim Cranston Ruth Hawker Michela Cox Beccy Summers Yunli Ou Leanne Bessell Ludwig Holzer Ross Clarkson Charlotte Macey-Woolmer Leigh Simpkins Sarah-Jane Hill Andy Waring Will Kivell Alice Foxen Samuel Withams Jade Barber Tarin Payne Thomas Boyling Kristin Houlgate Dane O'Reilly Jamie Sprake Dylan Evans Daniel Titcombe Gemma Abbott Peter Caine Ben Astley Vince McKenzie-Plume Jim Burn Ashley Ingram Paula Long Joe Phipps Lewis Hare Kirsty Walker Charlotte Copley James Keat Craig Chedzoy Leah Mason Rich Godfrey Dale Jefferies Nicole Morrison Kirsty Carpenter Steve Palmer Tara Marchant Sabrina Bolwell Tracy Hoad Stuart Stimson Collette Young Oscar Miller Joe Meering Ashley Watson Katharine Laurenson Lee Clarke John Carrielies Sharon Bowyer Adam Blinman Anna McCann Carrie-Anne Durrant Charlotte Blow Chris Taplin Marcus Goodwin Damon Godfrey Maree Holmes Rhys Allsopp Peter Willows Katrina Scott Sonia Wright-Stainton Stacey Lawrence Jacquiline Mullarney Lewis Garrood Tom Rutherford Luke Slocombe Alan Piper Julia Ryder Tom Driver Hannah Barber Joe Cartwright Loxley Patterson Chris Birch Kelly Chappell James Constable Naomi Miller Tara Rodda Tim Taylor Jason Trudgill Russell Hoskin Julie Legg Toni Howell Fergus Beeley Zoe Flowerdew Gary Rooney Cassandra Day Tamara Hoare Dylan Carey Lewis Murphy Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial BMJ Open |
| title | Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial |
| title_full | Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial |
| title_fullStr | Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial |
| title_full_unstemmed | Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial |
| title_short | Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial |
| title_sort | evaluation of the prehospital use of a valsalva assist device in the emergency treatment of supraventricular tachycardia evade svt study protocol for a stepped wedge cluster randomised controlled trial |
| url | https://bmjopen.bmj.com/content/13/6/e073315.full |
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evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT adamblinman evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT annamccann evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT carrieannedurrant evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT charlotteblow evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT christaplin evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT marcusgoodwin evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT damongodfrey evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT mareeholmes evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT rhysallsopp evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT peterwillows evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT katrinascott evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT soniawrightstainton evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT staceylawrence evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT jacquilinemullarney evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT lewisgarrood evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT tomrutherford evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT lukeslocombe evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT alanpiper evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT juliaryder evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT tomdriver evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT hannahbarber evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT joecartwright evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT loxleypatterson evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT chrisbirch evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT kellychappell evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT jamesconstable evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT naomimiller evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT tararodda evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT timtaylor evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT jasontrudgill evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT russellhoskin evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT julielegg evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT tonihowell evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT fergusbeeley evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT zoeflowerdew evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT garyrooney evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT cassandraday evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT tamarahoare evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT dylancarey evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial AT lewismurphy evaluationoftheprehospitaluseofavalsalvaassistdeviceintheemergencytreatmentofsupraventriculartachycardiaevadesvtstudyprotocolforasteppedwedgeclusterrandomisedcontrolledtrial |