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Meta-Analysis
. 2023 Apr 13;23(1):120.
doi: 10.1186/s12871-023-02076-2.

Comparison between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided arterial cannulation: a meta-analysis and systematic review

Lei Cao  1 , Yu-Ting Tan  1 , Ting Wei  1 , Hong Li  2
Affiliations
Meta-Analysis

Comparison between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided arterial cannulation: a meta-analysis and systematic review

Lei Cao et al. BMC Anesthesiol. .

Abstract

Background: The two most common methods for ultrasound-guided arterial cannulation are the long-axis in-plane (LA-IP) and short-axis out-of-plane (SA-OOP) approaches. However, it is uncertain which method is more advantageous. We conducted a meta-analysis of reported randomized clinical trials (RCTs) comparing the two techniques in terms of success rate, cannulation time, and complications.

Methods: We systematically searched PubMed, Embase, and the Cochrane Library database for RCTs comparing the LA-IP and SA-OOP techniques for ultrasound-guided arterial cannulation published from inception through April 31, 2022. The Cochrane Collaboration's Risk of Bias Tool was used to evaluate the methodological quality of each RCT. Review Manager 5.4 and Stata/SE 17.0 were used to analyze the two primary outcome measures (first-attempt success rate and total success rate) and two secondary outcome measures (cannulation time and complications).

Results: A total of 13 RCTs with 1,377 patients were included. There were no significant differences in first-attempt success rate (risk ratio [RR], 0.93; 95% confidence interval [CI], 0.78-1.12; P = 0.45; I2 = 84%) and overall success rate (RR, 0.99; 95% CI, 0.95-1.02; P = 0.48; I2 = 57%). When compared with the LA-IP technique, the SA-OOP technique was associated with an increased incidence of posterior wall puncture (RR, 3.01; 95% CI, 1.27-7.14; P = 0.01; I2 = 79%) and hematoma (RR, 2.15; 95% CI, 1.05-4.37; P = 0.04; I2 = 63%). There was no significant difference in the incidence of vasospasm between techniques (RR, 1.26; 95% CI, 0.37-4.23; P = 0.07; I2 = 53%).

Conclusions: The present results suggest that the SA-OOP technique is associated with a higher incidence of posterior wall puncture and hematoma than the LA-IP technique, whereas success rates are similar for the two ultrasound-guided arterial cannulation techniques. These findings should be experimentally evaluated in a more rigorous manner due to high inter-RCT heterogeneity.

Keywords: Arterial cannulation; Long-axis in-plane; Meta-analysis; Short-axis out-of-plane; Ultrasound-guided.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Cochrane Risk of Bias 2.0 Tool included randomized controlled trials. The green circle indicates low risk of bias, yellow circle indicates some concerns risk of bias
Fig. 3
Fig. 3
Summary of findings
Fig. 4
Fig. 4
The first-attempt success rate between SA-OOP and LA-IP
Fig. 5
Fig. 5
The total success rate between SA-OOP and LA-IP
Fig. 6
Fig. 6
The rate of hematoma between SA-OOP and LA-IP
Fig. 7
Fig. 7
The rate of posterior wall puncture between SA-OOP and LA-IP
Fig. 8
Fig. 8
The rate of vasospasm between SA-OOP and LA-IP
Fig. 9
Fig. 9
Subgroup analysis of the rate of hematoma by type of participant using a random effects model
Fig. 10
Fig. 10
Subgroup analysis of the rate of posterior wall puncture by type of participant using a random effects model
Fig. 11
Fig. 11
The trim and fill method for hematoma. The software estimated the number of missing to be 4
Fig. 12
Fig. 12
The plot of sensitivity analysis of hematoma
Fig. 13
Fig. 13
The plot of sensitivity analysis of vasospasm
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References

    1. Shiver S, Blaivas M, Lyon M. A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters. Acad Emerg Med. 2006;13(12):1275–1279. doi: 10.1197/j.aem.2006.07.015. - DOI - PubMed
    1. Bobbia X, Grandpierre RG, Claret PG, Moreau A, Pommet S, Bonnec JM, et al. Ultrasound guidance for radial arterial puncture: a randomized controlled trial. Am J Emerg Med. 2013;31(5):810–815. doi: 10.1016/j.ajem.2013.01.029. - DOI - PubMed
    1. Kiberenge RK, Ueda K, Rosauer B. Ultrasound-guided dynamic needle tip positioning technique versus palpation technique for radial arterial cannulation in adult surgical patients: a randomized controlled trial. Anesth Analg. 2018;126(1):120–126. doi: 10.1213/ANE.0000000000002261. - DOI - PubMed
    1. Nuttall G, Burckhardt J, Hadley A, Kane S, Kor D, Marienau MS, et al. Surgical and patient risk factors for severe arterial line complications in adults. Anesthesiology. 2016;124(3):590–597. doi: 10.1097/ALN.0000000000000967. - DOI - PubMed
    1. Gleich SJ, Wong AV, Handlogten KS, Thum DE, Nemergut ME. Major short-term complications of arterial cannulation for monitoring in children. Anesthesiology. 2021;134(1):26–34. doi: 10.1097/ALN.0000000000003594. - DOI - PubMed

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