Ultrasound-guided radial artery catheterization: a meta-analysis of randomized controlled trials

Abstract

Dear Editor, Radial artery catheterization is a frequent procedure for continuous blood pressure monitoring and arterial blood sampling in intensive care units. Traditional palpation technique for radial artery catheterization may be challenging in children. Ultrasound guidance has been used as an adjunct for central vein catheterization and has shown significant benefits over the traditional palpation technique [1]. However, the use of ultrasound guidance for radial arterial cannulation has not been well established. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the ultrasound guidance and traditional palpation techniques for radial artery catheterization. PubMed and Embase were searched for RCTs comparing the ultrasound guidance and traditional palpation for radial artery catheterization. Differences were expressed as relative risks (RRs) with 95 % confidence intervals (CIs) for dichotomous outcomes, and standardized mean differences (SMDs) with 95 % CIs for continuous outcomes. The metaanalysis was performed with the fixedor random-effects model according to the heterogeneity, which was tested using the Cochran’s Q test (p \ 0.1) and was quantified with the I statistic. A two-tailed p \ 0.05 was considered a significant level except for where a certain p value has been given. All statistical analyses were performed using Stata 12.0 software (StataCorp, College Station, TX, USA). Five RCTs enrolling 370 patients were included in the meta-analysis [2–6]. The main characteristics of the five included RCTs are presented in Table 1. Compared with the palpation method, ultrasound-guided radial artery catheterization was associated with a 84 % improvement in firstattempt success (RR 1.84, 95 % CI 1.47–2.32, p \ 0.0001), as well as in small children and infants (RR 1.90, 95 % CI 1.38–2.63, p \ 0.0001). Ultrasound-guided radial artery catheterization significantly reduced mean attempts to success (SMD -0.97, 95 % CI -1.38 to -0.55, p \ 0.0001), mean time to success (SMD -0.79, 95 % CI -1.03 to -0.54, p \ 0.0001), and the incidence of complication of hematoma (RR 0.17, 95 % CI 0.07–0.41, p \ 0.0001). In summary, ultrasound guidance is superior to traditional palpation for