• Ryszard Gawda, Maciej Marszalski, Maciej Piwoda, Maciej Molsa, Marek Pietka, Kamil Filipiak, Izabela Miechowicz, and Tomasz Czarnik.
• Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland.
• Crit. Care Med. 2024 Jan 1; 52 (1): 445344-53.

ObjectivesTo examine whether an ultrasound-guided infraclavicular cannulation of the axillary artery is noninferior to an ultrasound-guided cannulation of the common femoral artery for arterial catheter placement in critically ill patients.DesignProspective, investigator-initiated, noninferiority randomized controlled trial.SettingUniversity-affiliated ICU in Poland.PatientsMechanically ventilated patients with indications for arterial catheter placement.InterventionsPatients were randomly assigned into two groups. In the axillary group (A group), an ultrasound-guided infraclavicular, in-plane cannulation of the axillary artery was performed. In the femoral group (F group), an ultrasound-guided, out-of-plane cannulation of the common femoral artery was performed.Measurements And Main ResultsA total of 1,079 mechanically ventilated patients were screened, of whom 110 were randomized. The main outcome was the cannulation success rate. The secondary outcomes included the artery puncture success rate, the first-pass success rate, number of attempts required to puncture, and the rate of early mechanical complications. The cannulation success rate in the A group and F group was 96.4% and 96.3%, respectively. The lower limit of 95% CI for the difference in cannulation success rate was above the prespecified noninferiority margin of-7% demonstrating noninferiority of infraclavicular approach. No significant differences were found between the groups in terms of puncture success rate and the rate of early mechanical complications.ConclusionsAn ultrasound-guided infraclavicular cannulation of the axillary artery is noninferior to the cannulation of the common femoral artery in terms of procedure success rate. We found no significant differences in early mechanical complications between the groups.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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