Homam Moussa Pacha1, Fares Alahdab2, Yasser Al-Khadra3, Amr Idris4, Firas Rabbat5, Fahed Darmoch3, Mohamad Soud1, Anwar Zaitoun6, Amir Kaki7, Sunil V Rao8, Chun Shing Kwok9, Mamas A Mamas9, M Chadi Alraies10. 1. MedStar Washington Hospital Center, Washington, DC. 2. Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN. 3. Cleveland Clinic Foundation, Cleveland, OH. 4. University of Central Florida, Gainesville, FL. 5. Lincoln Medical Center, Bronx, NY. 6. St John Hospital and Medical Center, Detroit, MI. 7. Wayne State University, Detroit Medical Center, Heart Hospital, Detroit, MI. 8. The Duke Clinical Research Institute, Durham, NC. 9. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom. 10. Wayne State University, Detroit Medical Center, Heart Hospital, Detroit, MI. Electronic address: alraies@hotmail.com.
Abstract
BACKGROUND: The radial artery (RA) is routinely used for both hemodynamic monitoring and for cardiac catheterization. Although cannulation of the RA is usually undertaken through manual palpation, ultrasound (US)-guided access has been advocated as a mean to increase cannulation success rates and to lower RA complications; however, the published data are mixed. We sought to evaluate the impact of US-guided RA access compared with palpation alone on first-pass success to access RA. METHODS AND RESULTS: Meta-analysis of 12 randomized controlled trials comparing US-guided with palpation-guided radial access in 2,432 adult participants was done. Hemodynamic monitoring was the most common reason for RA catheterization. Only 2 randomized controlled trials evaluated patients undergoing cardiac catheterization. Ultrasound-guided radial access was associated with increased first-attempt success rate (risk ratio [RR] 1.35, 95% CI 1.16-1.57]) and decreased failure rate (RR 0.52, 95% CI 0.32-0.87). There were no significant differences in the risk of hematoma (RR 0.43, 95% CI 0.27-1.06), the mean time to first successful attempt (mean difference 25.13 seconds, 95% CI -1.06 to 51.34) or to any successful attempt (mean difference -4.74 seconds; 95% CI -22.67 to 13.18) between both groups. CONCLUSIONS: Ultrasound-guided technique for RA access has higher first-attempt success and lower failure rate compared with palpation alone, with no significant differences in access site hematoma or time to a successful attempt. These findings support the routine use of US guidance for RA access.
BACKGROUND: The radial artery (RA) is routinely used for both hemodynamic monitoring and for cardiac catheterization. Although cannulation of the RA is usually undertaken through manual palpation, ultrasound (US)-guided access has been advocated as a mean to increase cannulation success rates and to lower RA complications; however, the published data are mixed. We sought to evaluate the impact of US-guided RA access compared with palpation alone on first-pass success to access RA. METHODS AND RESULTS: Meta-analysis of 12 randomized controlled trials comparing US-guided with palpation-guided radial access in 2,432 adult participants was done. Hemodynamic monitoring was the most common reason for RA catheterization. Only 2 randomized controlled trials evaluated patients undergoing cardiac catheterization. Ultrasound-guided radial access was associated with increased first-attempt success rate (risk ratio [RR] 1.35, 95% CI 1.16-1.57]) and decreased failure rate (RR 0.52, 95% CI 0.32-0.87). There were no significant differences in the risk of hematoma (RR 0.43, 95% CI 0.27-1.06), the mean time to first successful attempt (mean difference 25.13 seconds, 95% CI -1.06 to 51.34) or to any successful attempt (mean difference -4.74 seconds; 95% CI -22.67 to 13.18) between both groups. CONCLUSIONS: Ultrasound-guided technique for RA access has higher first-attempt success and lower failure rate compared with palpation alone, with no significant differences in access site hematoma or time to a successful attempt. These findings support the routine use of US guidance for RA access.
Authors: Ronald Lg Flumignan; Virginia Fm Trevisani; Renato D Lopes; Jose Cc Baptista-Silva; Carolina Dq Flumignan; Luis Cu Nakano Journal: Cochrane Database Syst Rev Date: 2021-10-12
Authors: Zoltán Ruzsa; Ádám Csavajda; Balázs Nemes; Mónika Deák; Péter Sótonyi; Olivier F Bertrand; Béla Merkely Journal: J Endovasc Ther Date: 2020-10-12 Impact factor: 3.487