Publication: Ultrasound-guided arterial cannulation in adult: A systematic review and meta-analysis
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Date
2022
Authors
Sangasamy, Shamini
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Abstract
Background: Arterial cannulation is one of the most common procedures done in an acute care setting. However, the usage of ultrasound for artery cannulation has been controversial. This systematic review and meta-analysis were performed to assess the effectiveness of ultrasound in improving first attempt success rate, overall success rate, time to cannulation, number of attempts, and complications rate arterial cannulation in the adult population other techniques at all arterial cannulation sites. Methods: We included a randomized control trial in participants above 18 years old, undergoing arterial line placement or puncture in the emergency department, operating room, intensive care unit, and a cardiac catheterization lab. The primary outcomes of this meta-analysis are success rate upon the first puncture and overall success rate. Secondary outcomes are the time to successful cannulation, number of attempts to successful cannulation, and reported complications, including hematoma, bleeding, venipuncture, pseudoaneurysm, dissection, arteriovenous fistula, thrombosis, and retroperitoneal bleeding. Results: Total of 38 studies were included. We found that ultrasound substantially improved cannulation or puncture success rate, compare to palpation (RR 1.40, 95% CI 1.27 to 1.55; I2 statistic= 82%; P < 0.001), fluoroscopy (RR 1.47, 95% CI 1.17 to 1.85; I2 statistic= 95%; P < 0.001), Doppler (RR 1.35, 95% CI 1.11 to 1.64; P value 0.003) or vascular device (RR 0.76, 95% CI 0.48 to 1.2; P value 0.003) guided arterial cannulation at the first attempt. Upon comparing ultrasound with palpation group, ultrasound-guided significantly improved overall arterial cannulation success rate (RR 1.13, 95% CI 1.07 to 1.19; I2 statistic= 87%; P < 0.001). Conclusions: This meta-analysis provides the most comprehensive analysis of ultrasound-guided arterial cannulation in adults for all the arteries. The data supports the usage of ultrasound in arterial cannulation and should be used as the standard of practice in all clinical settings.
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Anesthesiology