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. 2024 Jul;28(7):677-685.
doi: 10.5005/jp-journals-10071-24751.

Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Lipi Mishra  1 , Chandra Rath  2   3   4 , Bradley Wibrow  1 , Matthew Anstey  1   4 , Kwok Ho  5   4
Affiliations

Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Lipi Mishra et al. Indian J Crit Care Med. 2024 Jul.

Abstract

Aim and background: Ultrasound-guided arterial catheterization is a frequently performed procedure. Additional techniques such as acoustic shadowing-assisted ultrasound may be useful in improving success rate. This systematic review aimed to assess the efficacy of acoustic shadowing assisted ultrasound for arterial catheterization.

Materials and methods: PubMed, Medline, EMBASE, Cochrane Library, EMCARE, and MedNar were searched in January 2024. Randomized controlled trials comparing the first attempt success rate of arterial catheterization using acoustic shadowing ultrasound vs unassisted ultrasound were included. Data were pooled for risk ratios (RRs) using the random-effects model. Subgroup analysis was conducted based on a single or double acoustic line. Sensitivity analysis was undertaken after excluding pediatric data. The certainty of evidence (COE) was assessed using the GRADE framework.

Results: Six randomized controlled trials (n = 777) were included. A meta-analysis found the first attempt success rate is significantly higher in the acoustic ultrasound group (n = 6, RR: 0.47, 95% CI: 0.34-0.66, p ≤ 0.00001). Hematoma formation was significantly less in the acoustic ultrasound group (n = 6, RR: 0.52, 95% CI: 0.34-0.80, p = 0.003). First attempt success was significantly higher in the single acoustic line ultrasound (USG) group compared to the unassisted ultrasound group (n = 3, RR: 0.41, 95% CI: 0.28-0.59, p ≤ 0.00001). Sensitivity analysis after excluding pediatric data was similar to the primary analysis (n = 5, RR: 0.50, 95% CI: 0.33-0.70, p ≤ 0.00001). Certainty of evidence was "Moderate" for the first attempt cannulation.

Conclusions: Acoustic shadowing-assisted ultrasound improved first-attempt arterial catheterization success rate and was associated with reduced hematoma formation.

How to cite this article: Mishra L, Rath C, Wibrow B, Anstey M, Ho K. Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2024;28(7):677-685.

Keywords: Acoustic shadow; Arterial cannulation; Ultrasound.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
Flowchart for study selection
Fig. 2
Fig. 2
Risk of bias and applicability concerns summary
Fig. 3
Fig. 3
Forest plot showing first attempt arterial cannulation success rate to be significantly better with the use of acoustic shadow compared to unassisted USG CI, confidence interval; IV, inverse variance; USG, ultrasound
Fig. 4
Fig. 4
Forest plot showing no significant difference in second attempt success rate between acoustic shadow and unassisted USG CI, confidence interval; IV, inverse variance; USG, ultrasound
Fig. 5
Fig. 5
Forest plot showing first attempt arterial cannulation success rate to be significantly better with the use of single acoustic shadow compared to unassisted USG CI, confidence interval; IV, inverse variance; USG, ultrasound
Fig. 6
Fig. 6
Forest plot showing significantly less hematoma formation in the acoustic USG group compared to unassisted USG CI, confidence interval; IV, inverse variance; USG, ultrasound
Fig. 7
Fig. 7
Forest plot did not show a significantly less time to canulation with acoustic assisted USG compared to unassisted USG CI, confidence interval; IV, inverse variance; USG, ultrasound
See this image and copyright information in PMC

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