Syncope: carotid sinus massage was safe.

Clinical bottom line (level 2b)

  1. TIAs and strokes were rare following carotid massage in patients with syncope not due to carotid bruits, ventricular arrhythmias or recent MI.
  2. Most deficits resolved.
Munro et al: Journal of the American Geriatric Society 1994; 42: 1248-1251
Expires October 2004

The study

Outcome study with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: two teaching hospitals, UK

1600 patients (aged ?, ?% male) 500 consecutive patients and 1100 patients with a diagnosis of dizziness, syncope, or falls had bilateral carotid massages for five seconds (supine and erect) with ECG and blood pressure monitoring

Excluded if
  • carotid bruits
  • ventricular tachycardia or fibrillation
  • recent MI





    • Outcomes studied:
  • TIA or minor stroke

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    TIA or minor stroke ? 7/1600 0.44%
    (0.11% to 0.76%)

    • Five developed pyramidal signs (one stroke worsened permanently) and two had visual field losses (one permanent).

    Citation

    1. Munro NC, McIntosh S, Lawson J, et al: Incidence of complications after carotid sinus massage in older patients with syncope. Journal of the American Geriatric Society 1994; 42: 1248-1251
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient syncope
    Intervention or Exposure carotid massage
    Outcome TIA, stroke