School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia Wagga Wagga Base Hospital, Wagga Wagga, NSW, Australia
Wagga Wagga Base Hospital, Wagga Wagga, NSW, Australia.
Br J Anaesth. 2016 May;116(5):610-7. doi: 10.1093/bja/aew097.
Ultrasound is a well-validated adjunct to central venous cannulation; however, previous reviews of ultrasound-guided radial artery cannulation have been inconclusive. The aim of this study was to assess the use of ultrasound in radial artery cannulation in adult and paediatric populations.
A systematic search of five major databases for all relevant articles published until November 2015 was conducted. Randomized controlled trials of radial artery cannulation with and without ultrasound guidance were included. All studies were assessed for level of evidence and risk of bias. Studies were grouped in adult and paediatric populations for each outcome. A meta-analysis was performed to analyse the data.
Eleven randomized controlled trials (six adult and five paediatric) were found. In both the adult and paediatric populations, there was high-level evidence for significantly improved first-attempt success rate and number of attempts with the use of ultrasound guidance.
This is the first level one systematic review to demonstrate strong evidence for the use of ultrasound guidance in radial artery cannulation in adult and paediatric populations. In the adult population, ultrasound use significantly increased first-attempt success rate, which subsequently resulted in a significant reduction in the number of attempts. The benefits of ultrasound were also shown in the paediatric population, with a significant increase in first-attempt success rate and reduction in the number of attempts. The use of ultrasound as an adjunct to radial arterial cannulation should now be considered best practice.
超声是一种经过充分验证的中心静脉置管辅助手段；然而，之前对超声引导桡动脉置管的综述结果并不一致。本研究旨在评估超声在成人和儿科人群桡动脉置管中的应用。
系统检索了截至 2015 年 11 月发表的所有相关文章的五个主要数据库。纳入了有和没有超声引导的桡动脉置管的随机对照试验。所有研究均评估了证据水平和偏倚风险。对于每个结果，研究分为成人和儿科人群进行分组。对数据进行了荟萃分析。
共发现 11 项随机对照试验（6 项成人研究，5 项儿科研究）。在成人和儿科人群中，超声引导均显著提高了首次尝试成功率和尝试次数，具有高级别证据。
这是第一项一级系统综述，证明了在成人和儿科人群中，超声引导在桡动脉置管中具有强有力的应用证据。在成人人群中，超声的使用显著提高了首次尝试成功率，进而显著减少了尝试次数。超声在儿科人群中的优势也得到了证实，首次尝试成功率显著提高，尝试次数减少。因此，将超声作为桡动脉置管的辅助手段应该被视为最佳实践。
