Modified carotid sinus massage using an ultrasonography for maximizing vagal tone: a crossover simulation study

Seung Min Ha; Young Suk Cho; Gyu Chong Cho; Choong Hyun Jo; Ji Young Ryu

doi:10.1016/j.ajem.2015.04.011

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Modified carotid sinus massage using an ultrasonography for maximizing vagal tone: a crossover simulation study☆☆☆★★★

Seung Min Ha, MD¹

Young Suk Cho, MD¹

Gyu Chong Cho, MD, PhD

Choong Hyun Jo, MD

Ji Young Ryu, MD

Department of Emergency Medicine, School of Medicine, Hallym University, 445 Gil-dong, Gang-dong gu, Seoul 134-701, Republic of Korea

¹Contributed equally to this study.

Published Online: April 10, 2015

Open Access

DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.011

Article Info

Fig. 1

Visual representation of the comparing of the position of the 2 points obtained with each maneuver. The x-axis was defined as the midline of the neck and the y-axis as the angle of the mandible. The distance between the points was determined by measuring with a ruler.

Fig. 2

Distribution of the pressure points obtained with each maneuver. The location of the conventional CSM is shown as a hollow, round shape and that of the modified CSM is shown as a solid, diamond shape. The pressure point of the modified CSM tended to be located more laterally and superiorly than the point of the conventional CSM.

Abstract

Introduction

The aim of this study was to ascertain if a modified carotid sinus massage (CSM) using ultrasonography is superior to the conventional CSM for vagal tone generation.

Methods

This was a prospective, crossover, clinical trial including 30 subjects with sinus rhythm. Participants were paired, and they performed 2 types of CSM to each other. To perform the conventional technique, pressure was exerted at the point where the maximal impulse of the carotid pulse was palpated. In the modified technique, participants localized the point of maximal diameter just above the bifurcation of the common carotid artery using ultrasonography and applied pressure to that point. Mean differences between premaneuver and postmaneuver R-R intervals and heart rates were compared. The distance from the midline of the neck (x distance) to the angle of the mandible (y distance) was measured, and the mean distance between the 2 techniques was compared.

Results

The baseline mean premaneuver R-R interval and heart rate did not differ significantly between the 2 techniques. The postmaneuver R-R interval and heart rate as well as the mean R-R interval and heart rate differences were significantly greater in the modified CSM. The mean location determined using the modified CSM was located 0.8 cm lateral and 0.8 cm superior to the mean location of the conventional CSM.

Conclusion

The modified CSM using ultrasonography might be more useful than the conventional CSM in reverting episodes of paroxysmal supraventricular tachycardia and may be a suitable alternative for treating the same in the emergency department.

☆Contributorship statement: GC Cho planned the study. SM Ha and CH Jo conducted the survey. YS Cho and JY Ryu analyzed the results. SM Ha and YS Cho contributed equally to this study as primary authors.

☆☆Funding: This study did not receive research funding from any funding agency.

★Conflict of interest: The authors declare no financial or other conflicts of interest relevant to the content of this manuscript.

★★Provenance and peer review: Not commissioned; externally peer reviewed.

Modified carotid sinus massage using an ultrasonography for maximizing vagal tone: a crossover simulation study☆☆☆★★★

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