What is the Pinard maneuver?

The Pinard Maneuver: Definition and Clinical Application

The Pinard maneuver is a vagal maneuver recommended for the acute treatment of supraventricular tachycardia (SVT), particularly in pregnant patients, where it serves as a first-line intervention to terminate SVT by stimulating the vagus nerve. 1

Technique and Execution

• The Pinard maneuver is a type of vagal maneuver that should be performed with the patient in the supine position 1
• It involves applying an ice-cold, wet towel to the face, based on the classic diving reflex 1
• In laboratory settings, facial immersion in water at 10°C (50°F) has proven effective in terminating tachycardia 1

Clinical Context and Efficacy

• Vagal maneuvers, including the Pinard maneuver, are recommended as first-line interventions for acute treatment of SVT before proceeding to pharmacological options 1
• These maneuvers work by stimulating the vagus nerve, which typically will not be effective if the rhythm does not involve the AV node as a requisite component of a reentrant circuit 1
• When compared with other vagal maneuvers, studies have shown varying success rates, with an overall success rate of 27.7% when switching between different techniques 1

Comparison to Other Vagal Maneuvers

• The Valsalva maneuver involves raising intrathoracic pressure by bearing down against a closed glottis for 10-30 seconds, equivalent to at least 30-40 mmHg 1
• Carotid sinus massage is performed after confirming absence of bruit by auscultation, applying steady pressure over the right or left carotid sinus for 5-10 seconds 1
• Studies have demonstrated that the Valsalva maneuver is more successful than carotid sinus massage in terminating SVT 1

Safety Considerations

• The Pinard maneuver is considered safe for use in pregnant patients 1
• Unlike the practice of applying pressure to the eyeball (which has been abandoned due to safety concerns), the Pinard maneuver has no significant safety issues when properly performed 1
• For pregnant patients, vagal maneuvers are recommended before pharmacological interventions to minimize fetal exposure to medications 1

Treatment Algorithm for SVT

1. Begin with vagal maneuvers including the Pinard maneuver as first-line treatment 1
2. If vagal maneuvers fail, proceed to adenosine as the next step in pregnant patients 1
3. For hemodynamically unstable patients where pharmacological therapy is ineffective or contraindicated, synchronized cardioversion is recommended 1

Important Caveats

• It's important to note that the Pinard name is also associated with the Pinard stethoscope used for fetal heart monitoring, which should not be confused with the Pinard maneuver for SVT 2
• The maneuver should be performed in a controlled setting where the patient can be monitored for response 1
• Proper execution of the technique is essential for maximizing efficacy 1