From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital (Y-EJ, E-HK, J-HL) and Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea (H-SK, J-TK).
Eur J Anaesthesiol. 2019 Oct;36(10):738-744. doi: 10.1097/EJA.0000000000001064.
Cannulation of the radial artery is challenging to perform in neonates and infants because of the small vessel size.
To compare guidewire-assisted with direct radial artery cannulation in neonates and infants.
A randomised controlled study.
A tertiary university hospital from 7 August 2017 to 4 July 2018.
Ninety neonates and infants who required radial artery cannulation during general anaesthesia.
All patients were allocated randomly into the guidewire group (guidewire-assisted cannulation, n=45) or control group (direct cannulation, n=45). Radial artery cannulation was performed under general anaesthesia. The contralateral radial artery was used if the arterial cannulation was not successful within two attempts. After the second failure in the contralateral radial artery, the case was considered a failure.
The primary outcome was the first-attempt success rate of radial artery cannulation. The secondary outcomes included the overall success rate, overall procedure time, number of attempts and use of the contralateral radial artery for radial artery cannulation.
The guidewire group showed a higher first-attempt success rate [76 vs. 56%; P = 0.046; odds ratio (OR) 2.47, 95% confidence interval (CI) of odds 1.01 to 6.08] and overall success rate (96 vs. 76%; P = 0.007; OR 6.96; 95% CI 1.44 to 33.52) than the control group. The overall procedure time was not significantly different between the guidewire group (median [IQR] 36 [28.0 to 70.5] s) and control group (98 [23.5 to 465.0] s; P = 0.400). There was no difference in the median number of attempts between the two groups (P = 0.454). However, use of the contralateral radial artery was significantly lower in the guidewire group (17.8%) than in the control group (40%; P = 0.020; OR 0.324, 95% CI 0.12 to 0.86). Kaplan-Meier analysis of the overall procedure time to successful radial artery cannulation showed that the overall success rate was significantly higher in the guidewire group than in the control group (P = 0.019).
For radial artery cannulation in neonates and infants, guidewire-assisted radial artery cannulation showed superiority over the direct technique in terms of first-attempt success rate and overall success rate without delaying the procedure time.
Clinicaltrials.gov (identifier: NCT03217019).
由于血管较小，新生儿和婴儿的桡动脉置管具有挑战性。
比较导丝辅助与直接桡动脉置管在新生儿和婴儿中的应用。
随机对照研究。
2017 年 8 月 7 日至 2018 年 7 月 4 日，一家三级大学医院。
90 名需要全身麻醉下桡动脉置管的新生儿和婴儿。
所有患者均随机分为导丝组（导丝辅助置管，n=45）或对照组（直接置管，n=45）。桡动脉置管在全身麻醉下进行。如果两次尝试均未成功，则使用对侧桡动脉。如果对侧桡动脉第二次置管失败，则视为失败。
桡动脉置管的首次尝试成功率为主要结局。次要结局包括总成功率、总操作时间、尝试次数和对侧桡动脉用于桡动脉置管的情况。
导丝组首次尝试成功率[76%比 56%；P=0.046；优势比（OR）2.47，95%置信区间（CI）的比值为 1.01 至 6.08]和总成功率（96%比 76%；P=0.007；OR 6.96；95%CI 1.44 至 33.52）均高于对照组。导丝组的总操作时间（中位数[IQR]36[28.0 至 70.5]s）与对照组（98[23.5 至 465.0]s；P=0.400）无显著差异。两组尝试次数的中位数无差异（P=0.454）。然而，导丝组对侧桡动脉的使用率（17.8%）明显低于对照组（40%；P=0.020；OR 0.324，95%CI 0.12 至 0.86）。桡动脉置管成功的总体操作时间的 Kaplan-Meier 分析显示，导丝组的总成功率明显高于对照组（P=0.019）。
对于新生儿和婴儿的桡动脉置管，导丝辅助桡动脉置管在首次尝试成功率和总成功率方面优于直接技术，且不会延长手术时间。
Clinicaltrials.gov（标识符：NCT03217019）。
