Comparison of Combined Long- and Short-Axis Laser-Assisted Ultrasound-Guided Radial Artery Cannulation With Long-Axis...

Radial artery cannulation often presents significant challenges in clinical practice. The authors' team developed an ultrasound-guided device that combines long- and short-axis imaging with laser guidance and manipulator-arm assistance. The authors hypothesized that its use would significantly improve the first-attempt success rate of adult radial artery cannulation compared with the traditional long-axis in-plane technique.

Single-center, prospective, parallel-group, randomized controlled study.

Tertiary academic cardiac hospital.

This study recruited 260 adult patients scheduled for general anesthesia who required radial artery cannulation.

The participants were randomly assigned to either the long-axis in-plane ultrasound guidance group or the long- and short-axis laser-assisted ultrasound guidance group. Two experienced operators performed radial artery cannulation on patients under local anesthesia in the preanesthesia room.

The primary outcome was the first-attempt success rate. Secondary outcomes included the total success rate, time to success on the first attempt, time to success within 2 attempts, total procedural time, ultrasound positioning time, number of needle-tip adjustments, number of attempts, use of the penetration method, rate of puncture-site change, and incidence of complications. The first-attempt success rate was significantly higher in the long- and short-axis laser-assisted ultrasound guidance group (119 of 130 patients [92%]) than in the long-axis in-plane ultrasound guidance group (94 of 130 patients [72%]), with an absolute difference of 20% (95% confidence interval [CI], 10.0%-28.3%; p < 0.001). For secondary outcomes, the overall success rate was higher in the long- and short-axis laser-assisted group (128 of 130 patients [98%]) than in the long-axis in-plane group (114 of 130 patients [88%]), with an absolute difference of 10% (95% CI, 4.8%-17.6%; p = 0.001). There was no significant difference in time to success on the first attempt between the two groups (median [interquartile range (IQR)], 29 seconds [24-35 seconds] v 32 seconds [24-38 seconds]; p = 0.09). However, time to success within 2 attempts and total procedural time were shorter in the long- and short-axis laser-assisted group than in the long-axis in-plane group (median [IQR], 30 seconds [25-36 seconds] v 36 seconds [26-41 seconds], p = 0.005, and 30 seconds [25-36 seconds] v 37 seconds [27-67 seconds], p < 0.001, respectively). In addition, the long- and short-axis laser-assisted group had significantly shorter ultrasound localization time (median [IQR], 9 seconds [7-11 seconds] v 18 seconds [14-21 seconds]; p < 0.001), fewer needle-tip adjustments (median [IQR], 0 [0-1] v 2 [1-3]; p < 0.001), fewer attempts (median [IQR], 1 [1-1] v 1 [1-2]; p < 0.001), lower use of the penetration method (8 patients [6%] v 33 patients [25%], p < 0.001), fewer puncture-site changes (10 patients [8%] v 25 patients [19%], p = 0.006), lower incidence of hematoma (5 patients [4%] v 28 patients [22%], p < 0.001), and lower incidence of vasospasm (9 patients [7%] v 22 patients [17%], p = 0.013). No distal ischemia of the punctured artery occurred in either group.

Compared with long-axis in-plane ultrasound guidance, long- and short-axis laser-assisted ultrasound guidance for radial artery cannulation significantly improved the first-attempt and total success rates while reducing positioning time and complications. These benefits may be attributable to 3-dimensional precise positioning, laser guidance, and manipulator-arm assistance, which support procedural stability throughout cannulation.