Ultrasound imaging for pediatric central venous catheterization: A systematic review of observational studies and RCTs Koji Hosokawa, Nobuaki Shime, Graeme Maclaren, Fuhong Su, Satoru Hashimoto Department of Anesthesia and Intensive Care, Kyoto Prefectural University of Medicine, Japan Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center, Japan Cardiothoracic ICU, National University Hospital, Singapore Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium Department of Intensive Care Medicine, University Hospital, Kyoto Prefectural University of Medicine, Japan Background/Purpose: Ultrasound imaging for locating vessels may help percutaneous central venous catheterizations. Earlier systematic reviews of randomized controlled trials (RCTs) highlighted a lack of sufficient information on this topic in pediatrics. The aim of this study was to evaluate its effectiveness and safety in pediatrics by reviewing both nonrandomized observational studies and RCTs. Methods: PubMed was searched in March 2015. We included all studies, regardless of methodology, which compared the success rates of internal jugular or femoral venous cannulations with ultrasound imaging and the anatomic landmark technique. Random-effects metaanalysis was conducted to estimate odds ratios (OR). Results:Out of 1106 citations, 6 non-RCTs and 9 RCTs enrolling 1711 patients were eligible. Seven RCTs had high risk of bias. In the 6 nonRCTs, the ultrasound imaging showed higher success rates than the anatomical landmark technique (OR, 0.35; P b .01) and fewer arterial punctures (OR, 0.36; P b .01). In the 9 RCTs, the ultrasound imaging also showed higher success rates than the landmark technique (OR, 0.22; P b .01) and tended toward fewer arterial punctures (OR, 0.31; P = .07). Time to successful cannulation and the number of attempts were reported only in a small number of studies. Conclusions: Based on this meta-analysis of non-RCTs and RCTs, ultrasound imaging is likely to achieve higher success and fewer arterial punctures than the landmark technique in pediatrics. However, other clinically important questions remain, and further studies are needed to determine the impact of ultrasound imaging on relevant outcomes.
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