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RAUST: Ultrasound guidance facilitates transradial access
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Real-time ultrasound guidance was associated with improved success and efficiency of radial artery cannulation in patients who presented for transradial cardiac catheterization, according to results of the RAUST trial.
The prospective, multicenter, controlled trial included patients undergoing transradial catheterization who were randomly assigned needle insertion with real-time ultrasound guidance (n = 347) or with palpation (n = 351).
The primary endpoints included number of forward attempts required for access, first-pass success rate and time to access.
Ultrasound guidance reduced the number of attempts required for access vs. palpation (mean, 1.65 ± 1.2 vs. 3.05 ± 3.4; P < .0001). The first-pass success rate was improved with ultrasound guidance vs. palpation (64.8% vs. 43.9%; P < .0001). Mean time to access was 88 ± 78 seconds with ultrasound guidance vs. 108 ± 112 seconds with palpation (P = .006). Ultrasound guidance reduced the number of difficult access procedures, defined as any procedure requiring five or more attempts and any procedure requiring 5 minutes or more in time (P < .001 for both).
After 5 minutes of failed palpation attempts, 10 patients in the control group crossed over to ultrasound guidance; 80% of those crossover patients experienced successful sheath insertion with ultrasound guidance.
Clinical outcomes, including patient pain score, bleeding complications and operator-reported spasm rates, were not significantly different between the ultrasound guidance and palpation groups.
According to univariable analyses, there was a weak but significant correlation between radial artery spasm and number of attempts and time to access. Patients with spasm had a median of three attempts and median time of access of 99 seconds compared with one attempt and 65 seconds for patients without spasm (P = .008 for attempts; P = .011 for time). Twenty-one percent of patients with spasm also had documented peripheral vascular disease vs. 3% of patients without spasm (P = .003).
“These results suggest that ‘seeing’ the small radial artery on US may be more accurate than ‘feeling’ the artery, due to the 2- to 4-mm 2-point discrimination limit of fingertip palpation. US guidance is particularly useful in those patients with difficult access with palpation alone. … Familiarity with the technique will likely benefit transradial operators whether the technique is used routinely or as a rescue technique after initial palpation attempts fail,” the researchers wrote. – by Rob Volansky
Disclosure: One researchers reports an association with Abbott Vascular.
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