Comparison of Combined Long- and Short-Axis Laser-Assisted Ultrasound-Guided Radial Artery Cannulation With Long-Axis Ultrasound Guidance in Adults: A Randomized Clinical Trial.

OBJECTIVES: 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. DESIGN: Single-center, prospective, parallel-group, randomized controlled study. SETTING: Tertiary academic cardiac hospital. PARTICIPANTS: This study recruited 260 adult patients scheduled for general anesthesia who required radial artery cannulation. INTERVENTIONS: 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. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.