Real-Time Ultrasound Guidance Facilitates Transradial Access RAUST (Radial Artery Access With Ultrasound Trial)
JACC Cardiovasc Interv
OBJECTIVES This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access. BACKGROUND US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multi-center randomized fashion for transradial cardiac catheterization. METHODS We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization. Patients were randomized to needle insertion with either palpation or real-time US guidance (351 palpation, 347 US). Primary endpoints were the number of forward attempts required for access, first-pass success rate, and time to access. RESULTS The number of attempts was reduced with US guidance [mean: 1.65 +/- 1.2 vs. 3.05 +/- 3.4, p < 0.0001; median: 1 (interquartile range [IQR]: 1 to 2) vs. 2 (1 to 3), p < 0.0001] and the first-pass success rate improved (64.8% vs. 43.9%, p < 0.0001). The time to access was reduced (88 +/- 78 s vs. 108 +/- 112 s, p = 0.006; median: 64 [IQR: 45 to 94] s vs. 74 [IQR: 49 to 120] s, p = 0.01). Ten patients in the control group required crossover to US guidance after 5 min of failed palpation attempts with 8 of 10 (80%) having successful sheath insertion with US. The number of difficult access procedures was decreased with US guidance (2.4% vs. 18.6% for >= 5 attempts, p < 0.001; 3.7% vs. 6.8% for >= 5min, p = 0.07). No significant differences were observed in the rate of operator-reported spasm, patient pain scores following the procedure, or bleeding complications. CONCLUSIONS Ultrasound guidance improves the success and efficiency of radial artery cannulation in patients presenting for transradial catheterization. (C) 2015 by the American College of Cardiology Foundation.
Faculty; Northwell Researcher
School of Medicine; Northwell Health