Arnold H Seto1, Jonathan S Roberts2, Mazen S Abu-Fadel3, Steven J Czak4, Faisal Latif3, Suresh P Jain5, Jaffar A Raza5, Aditya Mangla5, Georgia Panagopoulos4, Pranav M Patel6, Morton J Kern7, Zoran Lasic5. 1. Division of Cardiology, Department of Medicine, Long Beach Veterans Affairs Medical Center, Long Beach, California; Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California. Electronic address: arnoldseto@yahoo.com. 2. Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida. 3. Cardiovascular Section, Department of Medicine, Veterans Affairs Medical Center and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. 4. Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York. 5. Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York; Jamaica Hospital Medical Center, New York, New York. 6. Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California. 7. Division of Cardiology, Department of Medicine, Long Beach Veterans Affairs Medical Center, Long Beach, California; Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California.
Abstract
OBJECTIVES: This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access. BACKGROUND: US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization. METHODS: We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization. Patients were randomized to needle insertion with either palpation or real-time US guidance (351 palpation, 347 US). Primary endpoints were the number of forward attempts required for access, first-pass success rate, and time to access. RESULTS: The number of attempts was reduced with US guidance [mean: 1.65 ± 1.2 vs. 3.05 ± 3.4, p < 0.0001; median: 1 (interquartile range [IQR]: 1 to 2) vs. 2 (1 to 3), p < 0.0001] and the first-pass success rate improved (64.8% vs. 43.9%, p < 0.0001). The time to access was reduced (88 ± 78 s vs. 108 ± 112 s, p = 0.006; median: 64 [IQR: 45 to 94] s vs. 74 [IQR: 49 to 120] s, p = 0.01). Ten patients in the control group required crossover to US guidance after 5 min of failed palpation attempts with 8 of 10 (80%) having successful sheath insertion with US. The number of difficult access procedures was decreased with US guidance (2.4% vs. 18.6% for ≥5 attempts, p < 0.001; 3.7% vs. 6.8% for ≥5min, p = 0.07). No significant differences were observed in the rate of operator-reported spasm, patient pain scores following the procedure, or bleeding complications. CONCLUSIONS:Ultrasound guidance improves the success and efficiency of radial artery cannulation in patients presenting for transradial catheterization. (Radial Artery Access With Ultrasound Trial [RAUST]; NCT01605292).
RCT Entities:
OBJECTIVES: This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access. BACKGROUND: US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization. METHODS: We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization. Patients were randomized to needle insertion with either palpation or real-time US guidance (351 palpation, 347 US). Primary endpoints were the number of forward attempts required for access, first-pass success rate, and time to access. RESULTS: The number of attempts was reduced with US guidance [mean: 1.65 ± 1.2 vs. 3.05 ± 3.4, p < 0.0001; median: 1 (interquartile range [IQR]: 1 to 2) vs. 2 (1 to 3), p < 0.0001] and the first-pass success rate improved (64.8% vs. 43.9%, p < 0.0001). The time to access was reduced (88 ± 78 s vs. 108 ± 112 s, p = 0.006; median: 64 [IQR: 45 to 94] s vs. 74 [IQR: 49 to 120] s, p = 0.01). Ten patients in the control group required crossover to US guidance after 5 min of failed palpation attempts with 8 of 10 (80%) having successful sheath insertion with US. The number of difficult access procedures was decreased with US guidance (2.4% vs. 18.6% for ≥5 attempts, p < 0.001; 3.7% vs. 6.8% for ≥5min, p = 0.07). No significant differences were observed in the rate of operator-reported spasm, patientpain scores following the procedure, or bleeding complications. CONCLUSIONS: Ultrasound guidance improves the success and efficiency of radial artery cannulation in patients presenting for transradial catheterization. (Radial Artery Access With Ultrasound Trial [RAUST]; NCT01605292).
Authors: H Hoffman; M S Jalal; H E Masoud; R B Pons; I Rodriguez Caamaño; P Khandelwal; T Prakash; G C Gould Journal: AJNR Am J Neuroradiol Date: 2021-03-11 Impact factor: 3.825