Quality Improvement Study: Adenosine Administration in Pediatric Patients with SVT

Background: Supraventricular Tachycardia (SVT) is the most prevalent pediatric tachyarrhythmia requiring treatment, with an incidence rate of 1/100 to 1/250 children. Adenosine is the first-line diagnostic and therapeutic intervention for SVT, but its efficacy in pediatric patients varies. The conventional method of administering adenosine involves a 3-way stopcock. Study conducted by Weberding et.al concluded that the adenosine administration with a stopcock delivers less than intended adenosine particularly for patients that are less than 10kg. This quality improvement study aimed to rigorously assess the dose requirements for successful conversion during SVT in distinct pediatric weight groups (0-10kg, 10-20kg, >20kg). We hypothesized that children in the 0-10kg group would exhibit increased dosage needs due to potential medication loss in the 3-way stopcock.

Methods: Retrospective data were collected through chart review from Cook Children’s Emergency Department spanning 01/01/2018 to12/07/2023. The study encompassed 85 patients, stratified into three weight groups (0-10kg, 10-20kg, >20kg) with 21, 20, and 40 patients, respectively. Inclusion criteria comprised pediatric patients in SVT who received adenosine with or without symptom resolution. Exclusion criteria were patients receiving additional cardiac medications, cardioversion for SVT treatment, or those later found not to be in SVT initially.

Results: The results revealed that there was no association with group and number of doses needed to convert, x2=2.64, p=0.27. Although not significant, the 0-10 group had a higher proportion of patients needing more than 1 dose to convert (18% more than 10-20kg group and 20% more than 20 plus group). Despite statistical non-significance, 72% of patients in the >20 kg group required only a single dose for successful conversion, compared to 52% in the 0-10 kg and 70% in the 10-20 kg groups. These outcomes contradict our hypothesis; however, the limited sample size, especially in the 0-10 kg and 10-20 kg populations, may contribute to this non-significance.

Conclusion: Assumption tests revealed no violations for chi-square test. These findings imply that weight group may not exert a significant influence on the required adenosine doses for successful cardioversion in pediatric SVT cases. However, the 0-10 kg group had the highest percentage of patients requiring 2 or more doses. Thus, future studies should prioritize larger sample sizes to bolster statistical power, ensuring more definitive contributions to clinical practice. This study, sponsored by Cook Children’s Medical Center and UNT Health Science Center, was IRB exempt.