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Acad Emerg Med. 2019 Oct 30. doi: 10.1111/acem.13879. [Epub ahead of print]

Single Syringe Administration of Diluted Adenosine.

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Advocate Christ Medical Center, Department of Pharmacy, 4440 95th St, Oak Lawn, IL, 60453.
All authors conducted this research at Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL, 60453.
UMass Memorial Center, University Campus, Department of Pharmacy, 55 N Lake Ave, Worcester, MA, 01655.
Northwest Community Hospital, Department of Pharmacy, 800 W Central Rd, Arlington Heights, IL, 60005.
Community Healthcare System, Community Hospital, Department of Pharmacy, 901 MacArthur Blvd, Munster, IN, 46321.



A single-syringe of adenosine diluted in normal saline will be non-inferior to the standard two-syringe method for conversion of supraventricular tachycardia to normal sinus rhythm.


To compare the relative efficacy and safety of a novel route of administration of adenosine to usual care.


A single center, prospective, observational study was conducted from November 1, 2016 through February 28, 2018 on patients presenting to the emergency department in supraventricular tachycardia treated with adenosine. Drug was prepared by the pharmacist and method of administration was at the preference of the physician. Adenosine was either prepared as a single-syringe combined with a 0.9% sodium chloride flush to a total of 20ml or as the conventional two separate syringes; adenosine followed immediately by a 20 mL saline flush. Rates of conversion from supraventricular tachycardia to normal sinus rhythm were recorded.


A total of 53 patients were included in the analysis. Median number of doses administered in the single-syringe arm was one and three in the two-syringe arm. Conversion to normal sinus rhythm with first dose of adenosine was 73.1% and 40.7% for the single-syringe and conventional method respectively (p=0.0176). Successful conversion, after multiple doses, was 100% in the single-syringe arm and 70.4% in the two-syringe arm (p=0.0043). Adverse effects were minimal in both groups, 0% in the single-syringe arm and 3.85% in the undiluted cohort.


A single-syringe method of adenosine delivery is non-inferior to the conventional two-syringe method. Additionally, no adverse events were observed in the single-syringe method.


AVNRT; AVRT; Adenosine; Emergency Department; Supraventricular Tachycardia


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