Ultrasound-guided vascular catheterization in critically ill patients with nonpulsatile continuous circulation veno-arterial extracorporeal membrane oxygenation or ventricular assist device support

Abstract

Background Vascular access can be challenging in patients with obesity, impalpable pulsations, hemodynamic instability, thrombocytopenia, and coagulopathy. Our aim was to study the clinical effectiveness of vascular ultrasound (US) in arterial and venous catheterizations in critically ill patients with nonpulsatile circulation admitted at cardiac critical care units and to compare with the landmark techniques. Patients and methods This retrospective study included adult patients from January 2015 to January 2019 who had been admitted to the adult cardiac critical care unit with left ventricular assist device or veno-arterial extracorporeal membrane oxygenation and required vascular access. Results In 152 critically ill patients, 292 vascular catheters were inserted. The first-attempt success was achieved in 77.9 versus 34.6% (P=0.001) and the whole procedural success was 100 versus 67.5% (P=0.001) in the US and landmark groups, respectively. The number of attempts was 1.7±0.6 versus 1.2±0.4 (P=0.001) and the complications occurred in 2.5 versus 21.2% (P=0.001) in the US and landmark groups, respectively. Jugular catheterization was done in 42.9 versus 19.3% (P=0.001), while subclavian cannulation was done in 5 versus 42.3% (P=0.001) in the US and landmark groups, respectively. Iatrogenic pneumothorax happened in 0 versus 3.1% (P=0.001), accidental puncture of the adjacent artery happened in 0 versus 14.7% (P=0.001), and hematoma formation happened in 2.5 versus 9% (P=0.03) in the US and landmark groups, respectively. Conclusion Arterial and venous catheterizations guided by US in critically ill patients with nonpulsatile circulation and unstable hemodynamics were associated with higher success and more safety compared with the landmark techniques.