Ultrasound guidance compared to anatomic landmark approach for thoracentesis: A systematic review and meta-analysis

Although thoracentesis has traditionally been performed with anatomic landmarking, ultrasound guidance is increasingly used. The primary objective of this systematic review and meta-analysis is to determine the difference in success rates between ultrasound guidance versus anatomic landmark technique. Secondary outcomes include assessing the effects of ultrasound guidance on complication rates.

MEDLINE, Embase, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, LILACS, Web of Science Core Collection, Google Scholar, and the grey literature were searched for prospective randomized trials or cluster randomized trials comparing the success rate of ultrasound-guided to anatomic landmark thoracentesis in patients of all ages from inception to February 2024. Two investigators independently completed study screening, data extraction, and quality evaluations using the Cochrane Risk of Bias and GRADE tools. Outcomes were analyzed using random effects meta-analysis using generalized linear mixed effects models and corresponding 95 % confidence intervals (CI).

Three papers met inclusion criteria (n = 417 patients). Overall, ultrasound-guided thoracentesis was successful in 195 of 202 patients (96.5 %), and anatomic landmark thoracentesis was successful in 189 of 215 patients (87.9 %). Ultrasound-guidance trended towards higher success rates (OR 3.99, 95 % CI 0.60-26.50) and lower complication rates (OR 0.18, 95 % CI 0.01-3.07). Only two of the three studies evaluated post-procedure pneumothorax: in sum, 1/99 of the ultrasound group versus 20/113 in the anatomic landmark group were complicated by pneumothorax.

This systematic review and meta-analysis of randomized trials found that ultrasound guidance for thoracentesis trended towards increased success and lower complication rates compared to anatomic landmark technique.