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Guidewire-assisted vs. direct radial arterial cannulation in neonates and infants

A randomised controlled trial

Jang, Young-Eun; Kim, Eun-Hee; Lee, Ji-Hyun; Kim, Hee-Soo; Kim, Jin-Tae

European Journal of Anaesthesiology (EJA): October 2019 - Volume 36 - Issue 10 - p 738–744
doi: 10.1097/EJA.0000000000001064
Paediatric anaesthesia
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BACKGROUND Cannulation of the radial artery is challenging to perform in neonates and infants because of the small vessel size.

OBJECTIVE To compare guidewire-assisted with direct radial artery cannulation in neonates and infants.

DESIGN A randomised controlled study.

SETTING A tertiary university hospital from 7 August 2017 to 4 July 2018.

PATIENTS Ninety neonates and infants who required radial artery cannulation during general anaesthesia.

INTERVENTIONS 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.

MAIN OUTCOME MEASURES 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.

RESULTS 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).

CONCLUSION 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.

TRIAL REGISTRATION Clinicaltrials.gov (identifier: NCT03217019).

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)

Correspondence to Prof Jin-Tae Kim, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul 03080, Republic of Korea Tel: +82 2 2072 3295; fax: +82 2 745 5587; e-mail: jintae73@gmail.com

Published online 25 July 2019

© 2019 European Society of Anaesthesiology