title: Use of the human dive reflex for the management of supraventricular tachycardia: a review of the literature.
abstract: BACKGROUND
  The human dive reflex (HDR), a physiological phenomenon similar to the bradycardia reflex used by marine mammals during prolonged submersion, can be employed in managing paroxysmal supraventricular tachycardia (PSVT). This review aims to identify a standardised HDR technique for haemodynamically stable PSVT, to determine the effectiveness of the HDR and to define its usefulness in the prehospital setting.
  
  
  METHODS
  A review of the Medline, EMBASE and CINAHL databases was conducted. Articles were included if they described the use of the HDR to revert PSVT in the prehospital or emergency medical setting, the nature of the effectiveness of the HDR for PSVT or historically significant developments of HDR techniques for PSVT reversion. Articles not available in English or describing the use of HDR in animal studies only were excluded.
  
  
  RESULTS
  211 articles were identified, of which 21 were found to be relevant. These included 10 studies of HDR effectiveness in PSVT and three physiological studies of HDR effect. No standardised model of performance exists for the HDR. Elements of performance include: a cold stimulus applied to the entire face, a specific temperature of the cold stimulus, application duration, breath holding during HDR and posture assumed to perform the procedure. There are also safety and logistics issues with using the HDR in prehospital care.
  
  
  CONCLUSIONS
  The HDR represents an effective method of terminating PSVT in the hospital emergency department. Its usefulness in prehospital care requires further evaluation of the elements of the manoeuvre to determine appropriateness to this setting.
authors.affiliation: Department of Epidemiology and Preventative Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, Alfred Centre, 99 Commercial Road, Melbourne 3004, Australia. gavin.smith@monash.edu
authors.forename: Gavin
authors.initials: G
authors.lastname: Smith
authors.forename: Amee
authors.initials: A
authors.lastname: Morgans
authors.forename: David McD
authors.initials: DM
authors.lastname: Taylor
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
mesh_terms: D001919:Bradycardia; D017679:Cryotherapy / Q000379:methods; D004242:Diving / Q000502:physiology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007101:Immersion; D012018:Reflex / Q000502:physiology; D013617:Tachycardia, Supraventricular / Q000503:physiopathology / Q000628:therapy*