Singh Asha, Bahadorani Bobby, Wakefield Brett J, Makarova Natalya, Kumar Priya A, Tong Michael Zhen-Yu, Sessler Daniel I, Duncan Andra E
From the Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (A.S., B.B., B.J.W.); Departments of Quantitative Health Sciences and OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, Ohio (N.M.); Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina (P.A.K.); Outcomes Research Consortium, Cleveland, Ohio (P.A.K.); Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio (M.Z.-Y.T.); and Departments of OUTCOMES RESEARCH (D.I.S., A.E.D.) and Cardiothoracic Anesthesiology (A.E.D.), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
Anesthesiology. 2017 Jun;126(6):1065-1076. doi: 10.1097/ALN.0000000000001626.
Brachial arterial catheters better estimate aortic pressure than radial arterial catheters but are used infrequently because complications in a major artery without collateral flow are potentially serious. However, the extent to which brachial artery cannulation promotes complications remains unknown. The authors thus evaluated a large cohort of cardiac surgical patients to estimate the incidence of related serious complications.
The institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database and Perioperative Health Documentation System Registry of the Cleveland Clinic were used to identify patients who had brachial artery cannulation between 2007 and 2015. Complications within 6 months after surgery were identified by International Classification of Diseases, Ninth Revision diagnostic and procedural codes, Current Procedural Terminology procedure codes, and Society of Thoracic Surgeons variables. The authors reviewed electronic medical records to confirm that putative complications were related plausibly to brachial arterial catheterization. Complications were categorized as (1) vascular, (2) peripheral nerve injury, or (3) infection. The authors evaluated associations between brachial arterial complications and patient comorbidities and between complications and in-hospital mortality and duration of hospitalization.
Among 21,597 qualifying patients, 777 had vascular or nerve injuries or local infections, but only 41 (incidence 0.19% [95% CI, 0.14 to 0.26%]) were potentially consequent to brachial arterial cannulation. Vascular complications occurred in 33 patients (0.15% [0.10 to 0.23%]). Definitely or possibly related infection occurred in 8 (0.04% [0.02 to 0.08%]) patients. There were no plausibly related neurologic complications. Peripheral arterial disease was associated with increased risk of complications. Brachial catheter complications were associated with prolonged hospitalization and in-hospital mortality.
Brachial artery cannulation for hemodynamic monitoring during cardiac surgery rarely causes complications.
与桡动脉导管相比，肱动脉导管能更好地估计主动脉压力，但由于在无侧支血流的主要动脉中发生的并发症可能很严重，因此使用较少。然而，肱动脉插管引发并发症的程度尚不清楚。因此，作者评估了一大群心脏外科手术患者，以估计相关严重并发症的发生率。
利用克利夫兰诊所的机构胸外科医师协会成人心脏手术数据库和围手术期健康文档系统注册库，识别2007年至2015年间接受肱动脉插管的患者。通过国际疾病分类第九版诊断和程序编码、当前程序术语程序编码以及胸外科医师协会变量，确定术后6个月内的并发症。作者查阅电子病历，以确认假定的并发症与肱动脉插管有合理关联。并发症分为（1）血管性、（2）周围神经损伤或（3）感染。作者评估了肱动脉并发症与患者合并症之间的关联，以及并发症与住院死亡率和住院时间之间的关联。
在21597名符合条件的患者中，777人出现血管或神经损伤或局部感染，但只有41例（发生率0.佃％[95％CI，0.14至0.26％]）可能是肱动脉插管所致。33例患者发生血管并发症（0.15％[0.10至0.23％]）。8例（0.04％[0.02至0.08％]）患者发生明确或可能相关的感染。没有合理相关的神经系统并发症。外周动脉疾病与并发症风险增加相关。肱动脉导管并发症与住院时间延长和住院死亡率相关。
心脏手术期间用于血流动力学监测的肱动脉插管很少引起并发症。
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