Written by Nickolas Srica
An initial dose of 12 mg of adenosine for suspected paroxysmal supraventricular tachycardia (PSVT) was associated with increased prehospital improvement, reduced rates of hospital admission, and less re-dosing compared to 6 mg, while complications remained rare and similar across both groups.
Pause before starting with 6 mg…
This was a retrospective observational analysis of prehospital patient data through the ESO Data Collaborative, a large EMS electronic health record dataset in the US. During the study period from January through December 2022, 11,245 patients across 1,350 EMS agencies received adenosine. 70% of those patients (n=7,825) received an initial dose of 6 mg while 30% (n=3,314) received 12 mg. Demographics, indications, and initial vital signs were similar across both groups. After adjustment, an initial dose of 12 mg was associated with 65% increased odds of prehospital improvement (OR 1.65, 95%CI 1.49-1.82), higher rate of needing a single dose (75% vs 52%, respectively), and reduced odds of hospital admission (OR 0.72, 95%CI 0.59-0.87), though hospital outcome data was only available for 25% of the study population. Major complications (cardioversion, pacing, CPR, death) following adenosine administration in the prehospital setting were rare and were similar between both dosing groups.
How does this change my practice?
Where I trained, the great Dr. Corey Slovis (ahem, one of the authors on this paper) would frequently say “go big or go home” in reference to starting with 12 mg of adenosine rather than 6 mg for PSVT. This study provides some more ammunition for the safety and efficacy of that practice.
Source
Comparing Prehospital Adenosine Initial Dosing of 6 mg Versus 12 mg for Presumed Paroxysmal Supraventricular Tachycardia (PSVT). Prehosp Emerg Care. 2025 Jun 5:1-6. doi: 10.1080/10903127.2025.2504521. Epub ahead of print. PMID: 40471550
