Carotid sinus massage in clinical practice: the Six-Step-Method

Six steps: (i) check history for exclusion of carotid sinus massage (CSM); (ii) turn head slightly contralaterally and posterior; (iii) palpate to identify carotid sinus location; (iv) massage for 10 s; (v) monitor BP and heart rate to assess haemodynamic response type; (vi) include time intervals between subsequent massages

Perform CSM on both left and right, in supine and upright position

Equipment: tilt table for supine and standing CSM, continuous BP monitor or cardiac monitor, and at least two persons