Abstract
BackgroundThe use of an ultrasound-guided technique for radial arterial catheterization has not been well established in pediatric patients. We conducted a systematic review and meta-analysis to evaluate the efficacy of the ultrasound-guided technique for radial artery catheterization in pediatric populations.MethodA systematic review of PubMed, Medline, Embase, and the Cochrane library was performed from their date of inception to December 2019. In this meta-analysis, we conducted online searches using the search terms “ultrasonography,” “ultrasonics,” “ultrasound-guided,” “ultrasound,” “radial artery,” “radial arterial,” “catheter,” “cannula,” and “catheterization.” The rate of the first-attempt and total success, mean attempts to success, mean time to success, and incidence of complications (hematomas) were extracted. Data analysis was performed with RevMan 5.3.5.ResultsFrom 7 relevant studies, 558 radial artery catheterizations were enrolled, including 274 ultrasound-guided and 284 palpation catheterizations. The ultrasound-guided technique could significantly improve the rate of first-attempt and total success (RR 1.78, 95% CI 1.46 to 2.18, P < 0.00001; RR 1.33; 95% CI 1.20 to 1.48; P < 0.00001). However, there was significant heterogeneity for the total success rate among the included studies (I2 = 67%). The ultrasound-guided radial artery catheterization was also associated with less mean attempts and mean time to success (WMD − 1.13, 95% CI − 1.58 to − 0.69; WMD − 72.97 s, 95% CI − 134.41 to − 11.52) and lower incidence of the hematomas (RR 0.17, 95% CI 0.07 to 0.41).ConclusionsThe use of the ultrasound-guided technique could improve the success rate of radial arterial catheterization and reduce the incidence of hematomas in pediatric patients. However, the results should be interpreted cautiously due to the heterogeneity among the studies.
Highlights
The use of an ultrasound-guided technique for radial arterial catheterization has not been well established in pediatric patients
The ultrasound-guided technique could significantly improve the rate of firstattempt and total success (RR 1.78, 95% Confidence intervals (CIs) 1.46 to 2.18, P < 0.00001; relative ratio (RR) 1.33; 95% CI 1.20 to 1.48; P < 0.00001)
The ultrasound-guided radial artery catheterization was associated with less mean attempts and mean time to success (WMD − 1.13, 95% CI − 1.58 to − 0.69; weighted mean difference (WMD) − 72.97 s, 95% CI − 134.41 to − 11.52) and lower incidence of the hematomas (RR 0.17, 95% CI 0.07 to 0.41)
Summary
Literature search Two hundred eighty-six articles were identified from electronic databases (excluding duplicates). Ultrasound-guided radial artery catheterization was associated with an increased firstattempt success (RR 1.78, 95% CI 1.46 to 2.18, P < 0.00001, Fig. 3), and no significant heterogeneity was shown among these studies (I2 = 24%). For the first-attempt success, no difference was detected between studies on elder children (one trial, RR 1.01, 95% CI 0.46 to 2.24), Fig. 3 Forest plot comparing the rate of first-attempt success (a) and total success (b) for ultrasound-guided versus palpation but a significant difference on small children and infants (five trials, RR 1.90, 95% CI 1.55 to 2.33). Six trials reported the total success rate on small children and infants, and a significant difference was detected between studies (RR 1.45, 95% CI 1.29 to 1.63) (Fig. 4). Secondary outcomes Similar to previous studies, ultrasound-guided radial artery catheterization was associated with less mean attempts to success (WMD − 0.96, 95% CI − 1.35 to − 0.56, P < 0.00001, Fig. 6), shorter mean time to success (WMD − 98.65 s, 95% CI − 142.02 to − 55.29, P < 0.00001, Fig. 6), and lower incidence of hematomas (RR 0.21, 95% CI 0.11 to 0.42, P < 0.00001, Fig. 7)
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