Ultrasound-Guided Out-of-Plane Versus In-Plane Radial Artery Cannulation in Adult Cardiac Surgical Patients

Arora, Nishant Ram; Maddali, Madan Mohan; Al-Sheheimi, Rashid A.; Al-Mughairi, Hajer; Panchatcharam, Sathiya Murthi

doi:10.1053/j.jvca.2020.08.025

Cited by 23 publications

(17 citation statements)

References 7 publications

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“…The sensitivity analysis showed that as for total cannulation time, the study from Abdalla and colleagues ( 19 ) provided a large source of heterogeneity, which decreased heterogeneity from 97 to 83% in this endpoint. Sensitivity analysis in hematoma showed great differences between the studies from Abdalla, ( 19 ) Nam, ( 10 ) Arora, ( 20 ), and Berk ( 21 ); however, we could not find the relationship among them.…”

Section: Discussioncontrasting

confidence: 68%

Comparison of out-of-plane short axis with in-plane long axis for ultrasound-guided radial arterial cannulation: A systematic review with trial sequential analysis of randomised controlled trials

Sun

et al. 2022

Front. Cardiovasc. Med.

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BackgroundIt is controversial whether the short-axis out-of-plane or long-axis in-plane approach is a better needling technique for ultrasound-guidance radial artery cannulation. We aimed to compare the efficacy and safety of the two approaches for ultrasound-guided radial artery cannulation.MethodsA systematic search of Medline, Embase, the Cochrane Library, and Web of Science for relevant articles published until 1 May 2021 was conducted. Randomised controlled trials comparing the long-axis in-plane with short-axis out-of-plane approaches were included. Review Manager software version 5.4, STATA version 14.2, and trial sequential analysis (TSA) version 0.9.5.10 Beta were used for statistical analysis. Risk of bias and methodological quality of all studies included in this review were assessed according to the Cochrane Collaboration tool for the risk of bias. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity.ResultsThe rate of cannula insertion success on the first attempt was similar between the short-axis out-of-plane and long-axis in-plane approaches (RR = 1.03; 95% CI: 0.83 to 1.28; P = 0.79; I2 = 83.0%). No significant differences were observed in total time to successful cannulation between the two approaches (MD = –3.9; 95% CI:-18.30 to 10.49; P = 0.6; I2 = 97%). However, the required information size for the success rate of the first attempt and total time to successful cannulation was not reached.ConclusionIt remains inconclusive whether short-axis out-of-plane is a better choice for radial arterial cannulation than the long-axis in-plane approach. Inexperienced operators may need more attempts and longer ultrasound location time with the short-axis out-of-plane technique.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021236098].

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Section: Discussioncontrasting

confidence: 68%

Comparison of out-of-plane short axis with in-plane long axis for ultrasound-guided radial arterial cannulation: A systematic review with trial sequential analysis of randomised controlled trials

Sun

et al. 2022

Front. Cardiovasc. Med.

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“…With the advances in ultrasound technology for arterial puncture, complications in the arterial puncture stage are reduced [ 13 , 14 ]. However, the application of ultrasonic probes in radial artery puncture mostly occurs in the puncture stage [ 15 – 17 ]. Few studies have investigated the extraction stage of radial artery catheters.…”

Section: Introductionmentioning

confidence: 99%

To Explore the Haemostatic Effect of Compression Haemostasis Using an Ultrasonic Probe under the Guidance of Ultrasound after Radial Artery Puncture

2021

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Objective. To evaluate a new haemostasis method using an ultrasound probe to compress the radial artery and haemostasis under direct vision to replace traditional manual compression of the radial artery. Methods. According to a random number table, 240 patients with gastrointestinal tumours who had undergone arterial puncture were divided into Group A (120 cases) and Group B (120 cases). In Group A, patients were under the guidance of ultrasound to confirm the vascular port, determine the compression position of the ultrasound probe, observe the degree of vascular deformation, and press the radial artery puncture port with pressure to stop bleeding under direct vision. In Group B, traditional manual compression was used. All patients received 5 min of compression for haemostasis, and haemostasis conditions were recorded after compression and 24 hours postoperatively. Results. The incidence of bleeding, haematoma, and skin ecchymosis at the puncture site after 5 minutes of compression in Group A was lower than that in Group B ( P < 0.05 ). No significant difference was found between the two groups at 24 hours after the operation ( P > 0.05 ). Conclusion. The method using an ultrasound probe to guide radial artery compression to haemostasis is better than traditional manual compression when applied for compression haemostasis after removing the radial artery catheter.

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“…We thank the Journal and the authors, Donauer et al, for their reply. 1 With transesophageal echocardiography (TEE), we attempted to measure the cardiac silhouette and estimate the anteroposterior (AP) length. A midesophageal aortic valve (AV) short-axis view was used to measure the distance from the probe to the endocardium of the right ventricle (RV) anteriorly before opening the chest and after chest closure.…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…Current European Society of Cardiology guidelines give a low-grade recommendation for ECMO usage in patients with circulatory collapse or cardiac arrest, reporting that it may be considered (class IIb À level of evidence C) in combination with surgical embolectomy or catheter-based treatment. 1 Caution is given regarding the use of ECMO in combination with systemic thrombolysis or as a stand-alone technique because of excessive risk of bleeding in one case and controversial efficacy in the other. The aim of the present study was to describe clinical characteristics and outcomes of high-risk acute PE patients treated with ECMO according to the first reperfusion strategy used (European Society of Cardiology guideli-nesÀrecommended strategy [surgical embolectomy or catheterbased treatment], systemic thrombolysis, or none).…”

mentioning

confidence: 99%

“…Cardiac arrest as indication for ECMO was significantly higher among patients who underwent systemic thrombolysis (81.1%) compared with patients who underwent surgical embolectomy or catheterbased treatment (57.6%) or who did not undergo reperfusion strategies (64.3%; p = 0.026). Rescue ECMO (bailout strategy) was more frequent in the systemic thrombolysis group (59.6%) compared with the surgical embolectomy or catheter-based treatment group (35.1%) and the no-reperfusion group (0.0%; p < 0.001); in contrast, immediate (upfront) 1 Considering the well-known ECMO-related complications and the potential effect on mortality of bleeding events, [2][3][4][5] a careful balance between expected benefits and risks is necessary in daily practice before applying each reperfusion therapy in PE patients needing invasive cardiopulmonary support. Despite current European Society of Cardiology guidelines recommendations, our systematic review showed that in the realworld, many PE patients ultimately receive ECMO along with systemic thrombolysis (at the expense of higher bleeding risk) or without any reperfusion therapy, apparently with similar inhospital survival.…”

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confidence: 99%

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Reperfusion Strategies in Patients With High-Risk Acute Pulmonary Embolism Needing Extracorporeal Membrane Oxygenation Support: A Systematic Review

Pagnesi

Baldetti

Beneduce

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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The probe (L15-7io; Philips, Amsterdam, Netherlands) used by the authors is marketed for vascular and intraoperative use. Even though this probe definitely can be used for vascular access (and certainly we have done so for many years), this is not its primary use.We think this is a crucial point because this probe, unlike (most) other commercially available products specifically designed for vascular access, lacks any guidance marker on its surface. As previously demonstrated, guidance markers are now physically available on the probe and virtually on the screen and have been shown to improve success of vascular cannulation. 2 Interestingly, in one of the studies cited by the authors, a "home-made" marker (created by using a stitch) was described. The OOP approach was superior in terms of first-attempt success rate compared with the IP approach in that study. 3 The IP and OOP techniques have different characteristics and are not, in our opinion, mutually exclusive. For example, OOP imaging undoubtedly provides an better lateral resolution, and this is especially useful for narrow vessels. In addition, when there are calcifications on the upper side of the artery (eg, from 11-to-1 o'clock), the artery can be approached and cannulated safely from the side (eg, from 10 or 2 o'clock). Unfortunately, this requires excellent needle-manipulating skills, and the unexperienced provider can find it more difficult and be less successful compared with a more experienced provider. Another issue that can prevent successful cannulation and also cause damage to surrounding structures is the inability to keep track of the needle tip. In fact, if the ultrasound beam is not aligned with the tip, then the needle shaft, which will appear as a bright point on the screen, similarly to its tip, can be mistaken for the tip, which in turn will be invariably deeper than expected and not on the screen.On the other hand, the IP technique provides a better view of the needle, especially the tip, 4 and is in concurrence with some anesthesiologists that the needle be viewed at all times. Unfortunately, in the case of small, narrow, or tortuous vessels (or in neonates/children), it is not uncommon for the novice to image the vessel in what is not its larger longitudinal dimension (ie, not along the plane that cuts the vessel vertically from 12-to-6 o'clock). Alternatively, even when a correct image is obtained, the needle can be slightly off plane and still look acceptable on the screen to the inexperienced user. Both of these situations can result in a lateral cannulation of the vessel. This lateral cannulation is not the "side-to-middle," intentional, and sought-after cannulation previously described in case of surface plaques but rather an "along-the-side," unintentional cannulation, which could result in inability to cannulate or even dissection of the vessel.For many years we have used a combined, hybrid approach whereby the artery initially is imaged with the OOP technique and the needle tip is advanced until it lies on the vessel at the 1...

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Ultrasound-Guided Out-of-Plane Versus In-Plane Radial Artery Cannulation in Adult Cardiac Surgical Patients

Cited by 23 publications

References 7 publications

Comparison of out-of-plane short axis with in-plane long axis for ultrasound-guided radial arterial cannulation: A systematic review with trial sequential analysis of randomised controlled trials

Comparison of out-of-plane short axis with in-plane long axis for ultrasound-guided radial arterial cannulation: A systematic review with trial sequential analysis of randomised controlled trials

To Explore the Haemostatic Effect of Compression Haemostasis Using an Ultrasonic Probe under the Guidance of Ultrasound after Radial Artery Puncture

Reperfusion Strategies in Patients With High-Risk Acute Pulmonary Embolism Needing Extracorporeal Membrane Oxygenation Support: A Systematic Review

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