Ultrasound may improve first-pass success in interventional heart procedures: JAMA

According to a new study by Canadian researchers, ultrasound can help reduce risk of venipuncture and number of arterial puncture attempts, as well as improve first-pass success when it comes to interventional heart procedures. Further use of ultrasonography for femoral entry did not reduce vascular or bleeding issues. The findings were published in the Journal of American Medical Association.

The higher risk of vascular problems and bleeding while using femoral artery access for cardiac procedures as opposed to radial access is a significant drawback. There is a need for methods to make femoral access safer. This study was carried out in order to ascertain if routinely employing ultrasonography guidance for femoral artery access for coronary angiography/intervention decreases bleeding or vascular problems.

The Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures (UNIVERSAL) randomized clinical study compares ultrasound-guided femoral access to no ultrasound for coronary angiography or intervention with planned femoral access in a multicenter, prospective, open-label trial. Between June 26, 2018, and April 26, 2022, patients were randomly assigned. Myocardial infarction patients with ST-elevation were not eligible. On a backdrop of fluoroscopic landmarking, the use of ultrasound guidance vs. the absence of ultrasonography guidance for femoral arterial access was compared. Significant vascular problems within 30 days or major bleeding based on the Bleeding Academic Research Consortium 2, 3, or 5 criteria make up the key composite outcome.

The key findings of this study were:

1. In the ultrasonography group, the main outcome occurred in 40 of 311 patients (12.9%), as opposed to 50 of 310 patients (16.1%) in the control group.

2. Academic Research Consortium bleeding rates 2, 3, or 5 were 10.0% (31 of 311) vs. 10.7%. (33 of 310).

3. Major vascular problems occurred at a rate of 6.4% (20 of 311) vs 9.4%. (29 of 310).

4. With similar timeframes to access, ultrasound technology increased first-pass success and decreased the number of venepuncture and artery puncture attempts.

In conclusion, the key events of bleeding or vascular problems were unaffected by the routine use of ultrasonography for femoral access. However, the danger and quantity of venipuncture attempts were decreased by ultrasonography. To show other potential advantages of ultrasonography-guided access, larger studies may be needed.

Reference: 

Jolly, S. S., AlRashidi, S., d'Entremont, M.-A., Alansari, O., Brochu, B., Heenan, L., Skuriat, E., Tyrwhitt, J., Raco, M., Tsang, M., Valettas, N., Velianou, J. L., Sheth, T., Sibbald, M., Mehta, S. R., Natarajan, M. K., Kelly, A., … Winter, J. (2022). Routine Ultrasonography Guidance for Femoral Vascular Access for Cardiac Procedures. In JAMA Cardiology. American Medical Association (AMA). https://doi.org/10.1001/jamacardio.2022.3399