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

Xia-Xuan Sun; Meng Lv; Wen-Ya Du; Yi Liu; Haixia Zhang; Yue-Lan Wang

doi:10.3389/fcvm.2022.983532

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

Front Cardiovasc Med. 2022 Oct 12:9:983532. doi: 10.3389/fcvm.2022.983532. eCollection 2022.

Authors

Xia-Xuan Sun^{1

2}, Meng Lv^{1

2}, Wen-Ya Du^{1

2}, Yi Liu¹, Haixia Zhang¹, Yue-Lan Wang^{1

2}

Affiliations

¹ Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Care Medicine, Jinan, China.
² Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.

Abstract

Background: It 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.

Methods: A 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.

Results: The 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; I ² = 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; I ² = 97%). However, the required information size for the success rate of the first attempt and total time to successful cannulation was not reached.

Conclusion: It 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].

Keywords: cannulation; catheterisation; long-axis in-plane; radial artery; short-axis out-of-plane; ultrasound guidance.

Publication types

Systematic Review

Grants and funding

This work was supported by the National Natural Science Foundation of China (82070078), the Key Program of Natural Science Foundation of Shandong Province (ZR2020KH009), Academic Promotion Programme of Shandong First Medical University (2019QL015), Taishan Scholars (ts20190981 and tsqn20181244), and Natural Science Foundation of Shandong Province (Grant number: ZR2016HL02).