Real-Time Ultrasound Guidance vs Landmark Technique for Subclavian Central Venous Cannulation
abstract
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We conducted a systematic review and meta-analysis to assess the effectiveness of real-time dynamic ultrasound-guided subclavian vein cannulation as compared to landmark technique in adult patients.
DATA SOURCES
PubMed and EMBASE until June 1, 2022, with the EMBASE search restricted to the last 5 years.
STUDY SELECTION
We included randomized controlled trials (RCTs) comparing the two techniques (real-time ultrasound-guided vs landmark) for subclavian vein cannulation. The primary outcomes were overall success rate and complication rate, whereas secondary outcomes included success at first attempt, number of attempts, and access time.
DATA EXTRACTION
Independent extraction by two authors according to prespecified criteria.
DATA SYNTHESIS
After screening, six RCTs were included. Two further RCTs using a static ultrasound-guided approach and one prospective study were included in the sensitivity analyses. The results are presented in the form of risk ratio (RR) or mean difference (MD) with 95% CI. Real-time ultrasound guidance increased the overall success rate for subclavian vein cannulation as compared to landmark technique (RR = 1.14; [95% CI 1.06-1.23]; p = 0.0007; I2 = 55%; low certainty) and complication rates (RR = 0.32; [95% CI 0.22-0.47]; p < 0.00001; I2 = 0%; low certainty). Furthermore, ultrasound guidance increased the success rate at first attempt (RR = 1.32; [95% CI 1.14-1.54]; p = 0.0003; I2 = 0%; low certainty), reduced the total number of attempts (MD = -0.45 [95% CI -0.57 to -0.34]; p < 0.00001; I2 = 0%; low certainty), and access time (MD = -10.14 s; [95% CI -17.34 to -2.94]; p = 0.006; I2 = 77%; low certainty). The Trial Sequential Analyses on the investigated outcomes showed that the results were robust. The evidence for all outcomes was considered to be of low certainty.
CONCLUSIONS
Real-time ultrasound-guided subclavian vein cannulation is safer and more efficient than a landmark approach. The findings seem robust although the evidence of low certainty.
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Additional Info
Disclosure statements are available on the authors' profiles:
Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis
Crit. Care Med. 2023 May 01;51(5)642-652, M Zawadka, L La Via, A Wong, O Olusanya, L Muscarà, C Continella, P Andruszkiewicz, F SanfilippoFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study evaluated real-time ultrasound guidance on the success rate of subclavian line placement. This meta-analysis showed that real-time ultrasound-guided subclavian vein cannulation significantly increased the success rate of the procedure with a risk ratio of 1.14. Additionally, ultrasound use resulted in greater success at first attempt, fewer attempts, lower complication rates, and shorter access time. These findings resulted in the study concluding that real-time ultrasound-guided subclavian line placement appeared to be more effective than landmark technique.