INTRODUCTION: The superiority of ultrasonic-guided compared with landmark-guided central venous catheter (CVC) placement is not well documented in the Emergency Department. OBJECTIVE: To systematically review the literature comparing success rates between ultrasonic- and landmark-guided CVC placement by ED physicians. METHODS: PubMed and EMBASE databases were searched for randomised controlled trials from 1965 to 2010 using a search strategy derived from the following PICO formulation: PATIENTS: Adults requiring emergent CVC placement except during cardiopulmonary resuscitation. INTERVENTION: CVC placement using real-time ultrasonic guidance. Comparator: CVC placement using anatomical landmarks. OUTCOME: Comparison of success rates of CVC placement between ultrasonic- versus landmark-guided techniques. ANALYSIS: Success rates between CVC placement methods using a Forest Plot (95% CI) calculated by Review Manager Version 5.0. RESULTS: Search identified 944 articles of which 938 were excluded by title/abstract relevance, two not randomised, one cardiac arrest, one no landmark control, one success rate not calculated. A single study of 130 patients (65 ultrasonic- vs 65 landmark-guided) selected for internal jugular vein placement remained. Successful internal jugular CVC was significantly (p=0.02) more likely in the ultrasound-guided (93.9%) compared with landmark-guided (78.5%) techniques with an OR of 1.2 (95% CI 1.0 to 1.4). Complications rates were significantly (p=0.04) lower in ultrasonic (4.6%) versus landmark (16.9%) technique, OR=3.7 (95% CI 1.1 to 12.5). CONCLUSION: Only one single high quality study illustrating that ED ultrasound- versus landmark-guided internal jugular catheter placement had higher success rates with lower complication rates.
INTRODUCTION: The superiority of ultrasonic-guided compared with landmark-guided central venous catheter (CVC) placement is not well documented in the Emergency Department. OBJECTIVE: To systematically review the literature comparing success rates between ultrasonic- and landmark-guided CVC placement by ED physicians. METHODS: PubMed and EMBASE databases were searched for randomised controlled trials from 1965 to 2010 using a search strategy derived from the following PICO formulation: PATIENTS: Adults requiring emergent CVC placement except during cardiopulmonary resuscitation. INTERVENTION: CVC placement using real-time ultrasonic guidance. Comparator: CVC placement using anatomical landmarks. OUTCOME: Comparison of success rates of CVC placement between ultrasonic- versus landmark-guided techniques. ANALYSIS: Success rates between CVC placement methods using a Forest Plot (95% CI) calculated by Review Manager Version 5.0. RESULTS: Search identified 944 articles of which 938 were excluded by title/abstract relevance, two not randomised, one cardiac arrest, one no landmark control, one success rate not calculated. A single study of 130 patients (65 ultrasonic- vs 65 landmark-guided) selected for internal jugular vein placement remained. Successful internal jugular CVC was significantly (p=0.02) more likely in the ultrasound-guided (93.9%) compared with landmark-guided (78.5%) techniques with an OR of 1.2 (95% CI 1.0 to 1.4). Complications rates were significantly (p=0.04) lower in ultrasonic (4.6%) versus landmark (16.9%) technique, OR=3.7 (95% CI 1.1 to 12.5). CONCLUSION: Only one single high quality study illustrating that ED ultrasound- versus landmark-guided internal jugular catheter placement had higher success rates with lower complication rates.
Authors: Christoph F Dietrich; Rudolf Horn; Susanne Morf; Liliana Chiorean; Yi Dong; Xin-Wu Cui; Nathan S S Atkinson; Christian Jenssen Journal: J Thorac Dis Date: 2016-09 Impact factor: 2.895
Authors: J Defosse; M Schieren; A Böhmer; V von Dossow; T Loop; F Wappler; M U Gerbershagen Journal: Anaesthesist Date: 2016-05-31 Impact factor: 1.041