Ultrasound-Guided Catheterization of the Femoral Artery
Medline, Excerpta Medica Database (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from their inception through October 1, 2013 using broad Medical Subject Heading (MeSH) and Emtree terms for arterial catheterization and ultrasonography. Conference proceedings (from 2009 to 2013) of the American Thoracic Society, the Society of Critical Care Medicine, the European Society of Intensive Care Medicine, the American College of Chest Physicians, the American Heart Association, the American College of Cardiology, the Society of Vascular Surgery, the Society of Interventional Radiology, and the Cardiovascular and Interventional Radiological Society of Europe were searched for relevant abstracts. The reference lists of any identified titles were searched. There were no language restrictions. We followed PRISMA guidelines on the reporting of meta-analyses. The search strategy is listed in Table 1.
Prospective, randomized controlled trials (RCTs) comparing femoral artery catheterization using real-time 2-dimensional (2D) ultrasound guidance techniques with traditional palpation techniques or a combination of palpation and fluoroscopy were included in the review. Trials evaluating the use of solely Doppler ultrasonography (without 2D ultrasound), marking techniques (without utilizing real-time guidance), or catheterization of other arteries were excluded. There were no age limitations. There were no language restrictions. Two reviewers independently evaluated the identified titles, confirmed eligibility, and extracted data. Discrepancies were resolved by consensus.
The methodological quality of selected trials was appraised by two independent reviewers using the Jadad criteria. The Jadad criteria include: (1) randomization of subjects; (2) the use of blinding; and (3) the completeness of subject follow-up.
The primary outcome was overall complication rate. The overall complication rate was defined as a compilation of local hematoma, retroperitoneal hematoma, puncture of the femoral vein, puncture of the superficial femoral artery, pseudoaneurysm formation, arteriovenous fistula formation, and arterial dissection.
Secondary outcomes were first-pass success rate, hematoma rate, venipuncture rate, number of attempts, and time of procedure. The secondary outcomes evaluated were not assessed or available for analysis in each trial. Analysis of the combined data was conducted using Review Manager (RevMan) version 5.2 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012). A random effects model was used to estimate the relative risk of dichotomous outcomes and associated 95% confidence intervals (CIs). Heterogeneity was assessed by visual assessment of the forest plot and formal statistical tests for heterogeneity. The χ test was used to assess whether observed differences in results was compatible with chance alone. A P-value <.10 provided evidence of heterogeneity of intervention effects. In addition, the I statistic was employed to describe the percentage of the variability in effect estimates that is due to heterogeneity rather than chance. Heterogeneity was considered significant if the I statistic exceeded 50%.
Methods
Medline, Excerpta Medica Database (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from their inception through October 1, 2013 using broad Medical Subject Heading (MeSH) and Emtree terms for arterial catheterization and ultrasonography. Conference proceedings (from 2009 to 2013) of the American Thoracic Society, the Society of Critical Care Medicine, the European Society of Intensive Care Medicine, the American College of Chest Physicians, the American Heart Association, the American College of Cardiology, the Society of Vascular Surgery, the Society of Interventional Radiology, and the Cardiovascular and Interventional Radiological Society of Europe were searched for relevant abstracts. The reference lists of any identified titles were searched. There were no language restrictions. We followed PRISMA guidelines on the reporting of meta-analyses. The search strategy is listed in Table 1.
Selection
Prospective, randomized controlled trials (RCTs) comparing femoral artery catheterization using real-time 2-dimensional (2D) ultrasound guidance techniques with traditional palpation techniques or a combination of palpation and fluoroscopy were included in the review. Trials evaluating the use of solely Doppler ultrasonography (without 2D ultrasound), marking techniques (without utilizing real-time guidance), or catheterization of other arteries were excluded. There were no age limitations. There were no language restrictions. Two reviewers independently evaluated the identified titles, confirmed eligibility, and extracted data. Discrepancies were resolved by consensus.
Validity Appraisal
The methodological quality of selected trials was appraised by two independent reviewers using the Jadad criteria. The Jadad criteria include: (1) randomization of subjects; (2) the use of blinding; and (3) the completeness of subject follow-up.
Statistical Analysis
The primary outcome was overall complication rate. The overall complication rate was defined as a compilation of local hematoma, retroperitoneal hematoma, puncture of the femoral vein, puncture of the superficial femoral artery, pseudoaneurysm formation, arteriovenous fistula formation, and arterial dissection.
Secondary outcomes were first-pass success rate, hematoma rate, venipuncture rate, number of attempts, and time of procedure. The secondary outcomes evaluated were not assessed or available for analysis in each trial. Analysis of the combined data was conducted using Review Manager (RevMan) version 5.2 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012). A random effects model was used to estimate the relative risk of dichotomous outcomes and associated 95% confidence intervals (CIs). Heterogeneity was assessed by visual assessment of the forest plot and formal statistical tests for heterogeneity. The χ test was used to assess whether observed differences in results was compatible with chance alone. A P-value <.10 provided evidence of heterogeneity of intervention effects. In addition, the I statistic was employed to describe the percentage of the variability in effect estimates that is due to heterogeneity rather than chance. Heterogeneity was considered significant if the I statistic exceeded 50%.
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