Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Department of Emergency Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
J Emerg Med. 2020 Dec;59(6):911-917. doi: 10.1016/j.jemermed.2020.07.029. Epub 2020 Sep 8.
More than 10 million arterial lines are placed annually worldwide, many of which happen in the emergency department. Before the introduction of point-of-care ultrasound, landmark-guided palpation (LMGP) was considered standard of care.
The objective of this study is to compare ultrasound-guided (USG) and LMGP of radial arterial line cannulation by novice emergency medicine interns.
This was a single-center, prospective, randomized controlled trial (NCT03326739) of a convenience sample of adult patients who presented to an urban, university hospital with 100,000 visits annually. There was no funding for this study. Patients who required an arterial line were blindly randomized into LMGP or USG groups. Only novice emergency medicine interns, defined as interns with <15 previous placements, who were not blinded, performed the cannulation. Statistical analyses included t and Fisher exact tests.
Forty patients were enrolled with 20 patients randomized to each group. USG had a first-pass success of 75% vs. 0% for LMGP (p < 0.00001) and an overall success of 100% vs. 15% for LMGP (p < 0.00001), a mean of 1.30 attempts vs. 2.95 attempts for LMGP (a difference of 1.65; p < 0.0001), and a mean time for placement of 264 s vs. 524 s for LMGP (a difference of 260; p = 0.0025). Of the failed LMGP, USG crossover was 100% successful with a mean of 1.37 attempts (95% confidence interval 0.58-2.16) and 180 s for placement (95% confidence interval 97.92-262.08). Five percent of LMGP had a complication vs. 0% for USG (p = 1.0).
USG improved first-pass and overall success of radial arterial line cannulation while reducing time to access and attempts when used by novice emergency medicine interns.
全球每年有超过 1000 万条动脉置管，其中许多发生在急诊科。在即时护理超声出现之前，基于体表标志的触诊（LMGP）被认为是标准的护理方法。
本研究旨在比较新手急诊医学住院医师进行的超声引导（USG）和 LMGP 桡动脉置管。
这是一项在城市大学医院进行的单中心、前瞻性、随机对照试验（NCT03326739），采用便利抽样法纳入成年患者。本研究没有资金支持。需要动脉置管的患者被随机分为 LMGP 或 USG 组。只有新手急诊医学住院医师（定义为之前置管次数少于 15 次的住院医师）进行置管，且他们未被设盲。统计分析包括 t 检验和 Fisher 确切检验。
共纳入 40 例患者，其中 20 例患者随机分配至每组。USG 的首次置管成功率为 75%，而 LMGP 为 0%（p<0.00001），总体成功率为 100%，而 LMGP 为 15%（p<0.00001），平均尝试次数为 1.30 次，而 LMGP 为 2.95 次（差异为 1.65；p<0.0001），置管时间为 264 s，而 LMGP 为 524 s（差异为 260；p=0.0025）。在失败的 LMGP 中，USG 交叉成功率为 100%，平均尝试次数为 1.37 次（95%置信区间为 0.58-2.16），置管时间为 180 s（95%置信区间为 97.92-262.08）。LMGP 的并发症发生率为 5%，而 USG 为 0%（p=1.0）。
在新手急诊医学住院医师中，USG 提高了桡动脉置管的首次置管成功率和总体成功率，同时减少了进入和尝试的时间。
