• Homam Moussa Pacha, Fares Alahdab, Yasser Al-Khadra, Amr Idris, Firas Rabbat, Fahed Darmoch, Mohamad Soud, Anwar Zaitoun, Amir Kaki, Sunil V Rao, Chun Shing Kwok, Mamas A Mamas, and M Chadi Alraies.
• MedStar Washington Hospital Center, Washington, DC.
• Am. Heart J. 2018 Oct 1; 204: 1-8.

BackgroundThe radial artery (RA) is routinely used for both hemodynamic monitoring and for cardiac catheterization. Although cannulation of the RA is usually undertaken through manual palpation, ultrasound (US)-guided access has been advocated as a mean to increase cannulation success rates and to lower RA complications; however, the published data are mixed. We sought to evaluate the impact of US-guided RA access compared with palpation alone on first-pass success to access RA.Methods And ResultsMeta-analysis of 12 randomized controlled trials comparing US-guided with palpation-guided radial access in 2,432 adult participants was done. Hemodynamic monitoring was the most common reason for RA catheterization. Only 2 randomized controlled trials evaluated patients undergoing cardiac catheterization. Ultrasound-guided radial access was associated with increased first-attempt success rate (risk ratio [RR] 1.35, 95% CI 1.16-1.57]) and decreased failure rate (RR 0.52, 95% CI 0.32-0.87). There were no significant differences in the risk of hematoma (RR 0.43, 95% CI 0.27-1.06), the mean time to first successful attempt (mean difference 25.13 seconds, 95% CI -1.06 to 51.34) or to any successful attempt (mean difference -4.74 seconds; 95% CI -22.67 to 13.18) between both groups.ConclusionsUltrasound-guided technique for RA access has higher first-attempt success and lower failure rate compared with palpation alone, with no significant differences in access site hematoma or time to a successful attempt. These findings support the routine use of US guidance for RA access.Copyright © 2018 Elsevier Inc. All rights reserved.

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