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Original Research: Pulmonary Procedures |

Ultrasound Guidance Facilitates Radial Artery Catheterization: A Meta-analysis With Trial Sequential Analysis of Randomized Controlled Trials

Wan-Jie Gu, MD; Xiang-Dong Wu, MSc; Fei Wang, MD, PhD; Zheng-Liang Ma, MD, PhD; Xiao-Ping Gu, MD, PhD
Author and Funding Information

Drs Ma and X.-P. Gu contributed equally to this manuscript.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

CORRESPONDENCE TO: Zheng-Liang Ma, MD, PhD, Department of Anesthesiology, Drum Tower Hospital, Medical College of Nanjing University, 321 Zhongshan Road, Nanjing 210008, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):166-179. doi:10.1378/chest.15-1784
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Published online

Background  Potential benefits and possible risks associated with ultrasound guidance compared with traditional palpation for radial artery catheterization are not fully understood.

Methods  We searched PubMed, Embase, and the Cochrane Library through July 2015 to identify randomized controlled trials that evaluated ultrasound guidance compared with traditional palpation for radial artery catheterization. Primary outcome was first-attempt failure. Secondary outcomes included mean attempts to success, mean time to success, and hematoma complications. A random-effects model was used to estimate relative risks (RRs) with 95% CIs.

Results  Twelve trials used dynamic two-dimensional (2-D) ultrasound guidance (N = 1,992) and two used Doppler ultrasound guidance (N = 666). Compared with traditional palpation, dynamic 2-D ultrasound guidance was associated with a reduced first-attempt failure (RR, 0.68; 95% CI, 0.52-0.87). Trial sequential analysis showed that the cumulative z curve crossed the trial sequential monitoring boundary for benefit establishing sufficient and conclusive evidence. Dynamic 2-D ultrasound guidance further reduced mean attempts to success, mean time to success, and hematoma complications. No evidence of publication bias was detected. Compared with traditional palpation, Doppler ultrasound guidance had no benefit on first-attempt failure (RR, 1.00; 95% CI, 0.87-1.15), which was confirmed by trial sequential analysis as the cumulative z curve entered the futility area.

Conclusions  The use of dynamic 2-D ultrasound guidance for radial artery catheterization decreases first-attempt failure, mean attempts to success, mean time to success, and the occurrence of hematoma complications. Dynamic 2-D ultrasound guidance is recommended as an adjunct to aid radial arterial catheterization.

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