• Ninfa Mehta, Walter Wallace Valesky, Allysia Guy, and Richard Sinert.
• Department of Emergency Medicine, Kings County Hospital/State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA.
• Emerg Med J. 2013 May 1;30(5):355-9.

IntroductionThe superiority of ultrasonic-guided compared with landmark-guided central venous catheter (CVC) placement is not well documented in the Emergency Department.ObjectiveTo systematically review the literature comparing success rates between ultrasonic- and landmark-guided CVC placement by ED physicians.MethodsPubMed and EMBASE databases were searched for randomised controlled trials from 1965 to 2010 using a search strategy derived from the following PICO formulation:PatientsAdults requiring emergent CVC placement except during cardiopulmonary resuscitation.InterventionCVC placement using real-time ultrasonic guidance. Comparator: CVC placement using anatomical landmarks.OutcomeComparison of success rates of CVC placement between ultrasonic- versus landmark-guided techniques.AnalysisSuccess rates between CVC placement methods using a Forest Plot (95% CI) calculated by Review Manager Version 5.0.ResultsSearch identified 944 articles of which 938 were excluded by title/abstract relevance, two not randomised, one cardiac arrest, one no landmark control, one success rate not calculated. A single study of 130 patients (65 ultrasonic- vs 65 landmark-guided) selected for internal jugular vein placement remained. Successful internal jugular CVC was significantly (p=0.02) more likely in the ultrasound-guided (93.9%) compared with landmark-guided (78.5%) techniques with an OR of 1.2 (95% CI 1.0 to 1.4). Complications rates were significantly (p=0.04) lower in ultrasonic (4.6%) versus landmark (16.9%) technique, OR=3.7 (95% CI 1.1 to 12.5).ConclusionOnly one single high quality study illustrating that ED ultrasound- versus landmark-guided internal jugular catheter placement had higher success rates with lower complication rates.

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