Every year, it is estimated that over 1 million cardiac catheterization procedures are performed in the United States. Traditionally, vascular access for cardiac catheterization procedures was obtained by femoral artery puncture; however, radial artery access has been associated with reduced access site and bleeding complications. Over the last decade, there has been an increased utilization of Point of Care ultrasound and its incorporation into medical education and daily practice. Whether the routine use of ultrasound to guide vascular access is efficacious and reduces complications is unknown. To address these concerns, multiple randomized controlled trials have been conducted to evaluate the benefits of utilizing point of care ultrasound on time quality metrics and rates of vascular access complications, and have yielded variable results. To enhance the power for assessing the effect of ultrasound on vascular access outcomes, we conducted a meta-analysis of trials examining the use of ultrasound guided vascular access compared with traditional techniques in adults who underwent diagnostic or interventional cardiac procedures via the femoral or radial artery.
We performed a systematic search of databases including PubMed, Medline, CENTRAL, and ClinicalTrials.gov from inception till February 2021 in accordance with the Preferred Reporting Items for Systematic review and Meta-Analyses guidelines. We included patients from randomized trials that used ultrasound to guide femoral or radial artery access compared with matched controls in patients who underwent diagnostic or therapeutic cardiac or other vascular procedures. The primary outcome of our meta-analysis was time to first successful vascular access, while secondary efficacy end points were odds of first pass success, odds of venipuncture, and significant hematoma development. Outcomes were analyzed as dichotomous variables, and odds ratios (OR) and their respective 95% confidence intervals (CI) were obtained using the Mantel-Haenszel method and a random-effects model was used. Continuous variables were reported as mean ± standard deviation (SD) and the mean difference (MD) along with their respective 95% CI’s were obtained. A two-tailed p-value <0.05 was used to indicate significance. Review Manager version 5.3 (RevMan; Cochrane Collaboration) was used to analyze all study data.
A total of 10 published RCTs, including a total of 5,397 patients were included in this meta-analysis (2,679 patients who underwent ultrasound guided access and 2,718 patients who underwent palpation or fluoroscopy guided vascular access). The mean age of study participants was 63.9±12.1 years, 35.7% had diabetes mellitus, and 65.9% of participants were men. Follow up duration ranged from several hours post-procedure up to 30 days. Nine trials reported data on time to successful vascular access. Overall, there was a statistically significant decrease in the time to successful vascular access (MD: -17.01 sec [95% CI, -27.25, –6.77]; p = 0.001, I 2 =75%) ( Figure 1 ) in patients randomized to ultrasound guided access compared with control. However, stratification by artery accessed showed a significant reduction in time to successful access among patients who underwent ultrasound guided femoral puncture (MD: -22.08 sec [95% CI, -34.50, –9.67]; p = 0.0005); meanwhile, no significant reduction was observed in those who underwent radial puncture (MD: -7.67 sec [95% CI, -27.86, 12.52]; p = 0.46).
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
