Meta-analysis of surgeon-performed central line placement: real-time ultrasound vs landmark technique

AbstractBackgroundMajor health care agencies recommend real-time ultrasound (RTUS) guidance during insertion of percutaneous central venous catheters (CVC) based on studies in which CVCs were placed by non-surgeons. We conducted a meta-analysis to compare outcomes for surgeon-performed RTUS-guided CVC insertion versus traditional landmark technique.MethodsA systematic review of the literature was performed identifying randomized controlled trials (RCT) and prospective “safety studies” of surgeon-performed CVC insertions comparing landmark to RTUS techniques. Searches were conducted in MEDLINE, Cochrane, and Web of Science™, with additional relevant articles identified through examination of the bibliographies and citations of the included studies. Two independent reviewers selected relevant studies that matched inclusion criteria, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. A meta-analysis was conducted using random effects models to compare success and complication rates.ResultsThree RCTs were identified totaling 456 patients. RTUS-guidance was associated with better first attempt success (OR 4.7, 95% CI: 1.5-14.7, P = 0.008) and overall success (OR 6.5, 95% CI: 2.7-15.7, P

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