ECHOGUIDE
Trial question
Is ultrasound guidance superior to landmark guidance in patients requiring urgent femoral arterial and venous catheterization?
Study design
Single center
Single blinded
RCT
Population
Characteristics of study participants
25.0% female
75.0% male
N = 136
136 patients (34 female, 102 male).
Inclusion criteria: patients requiring both urgent arterial and venous femoral catheterization.
Key exclusion criteria: age < 18 years; contraindication to femoral access; clinical indication for only one catheter.
Interventions
N=67 ultrasound-guided catheterization (identification of femoral artery and vein using ultrasound to guide catheter insertion).
N=69 landmark-guided catheterization (using anatomic landmarks by palpating the femoral pulse to guide catheter insertion).
Primary outcome
Occurrence of ≥ 1 mechanical complication
33%
58%
58.0 %
43.5 %
29.0 %
14.5 %
0.0 %
Ultrasound-guided
catheterization
Landmark-guided
catheterization
Significant
decrease ▼
NNT = 4
Significant decrease in occurrence of ≥ 1 mechanical complication (33% vs. 58%; OR 0.35, 95% CI 0.18 to 0.71).
Secondary outcomes
Significant increase in successful catheterization (96% vs. 74%; OR 7.5, 95% CI 2.1 to 27).
No significant difference in cannulation time (103 seconds vs. 121 seconds; AD -18 seconds, 95% CI -39.46 to 3.46).
Significant decrease in the number of punctures (2 vs. 3; AD -1 , 95% CI -1.84 to -0.16).
Safety outcomes
No significant differences in bleeding, late hematomas.
Significant differences in immediate complications (27% vs. 51%), late complications (10% vs. 23%).
Conclusion
In patients requiring both urgent arterial and venous femoral catheterization, ultrasound-guided catheterization was superior to landmark-guided catheterization with respect to occurrence of ≥ 1 mechanical complication.
Reference
Stephen Lazaar, Amélie Mazaud, Claire Delsuc et al. Ultrasound guidance for urgent arterial and venous catheterisation: randomised controlled study. Br J Anaesth. 2021 Dec;127(6):871-878.
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