Non-ED Randomised Controlled Trials
| Paper | N/Type | Group | Inter-vention | Outcome | Comments |
|---|---|---|---|---|---|
| CVC, central venous catherisation; ICU, intensive care unit; IJ, internal jugular vein; RCT, randomised controlled trial. | |||||
| Mallory et al15 1990 | 27 RCT (with partial crossover) | IJ CVC insertion in ICU patients by Senior ICU Staff | Failure rate | Small numbers | |
| Ultrasound | 0/12 | No power calculation | |||
| Landmark | 6/17 (p<0.05) | ||||
| Number of attempts | |||||
| Ultrasound | 1.75 | ||||
| Landmark | 3.12 (p<0.05) | ||||
| Success on crossover | |||||
| To Ultrasound | 6/6 | ||||
| Troianos et al16 1991 | 160 RCT | CVC insertion in Cardio-thoracic patients | Success Rate | No baseline statistics. | |
| Ultrasound | 77/77 | Randomisation process not described | |||
| Landmark | 80/83 (NS) | ||||
| First attempt success | |||||
| Ultrasound | 56/77 | ||||
| Landmark | 45/83 (p<0.05) | ||||
| Number of attempts | |||||
| Ultrasound | 1.4±0.7 | ||||
| Landmark | 2.8±3 (p<0.05) | ||||
| Time to insertion | |||||
| Ultrasound | 61±46 sec | ||||
| Landmark | 117±136 sec (p<0.05) | ||||
| Denys et al17 1993 | 604 (1230) RCT (302 Ultrasound vs 302 landmark followed by 626 patients Ultrasound only) | IJ CVC insertion in cardiac catheter patients by senior cardiologist | Success rate | Poor randomisation technique (one week blocks of Ultrasound or landmark) | |
| Ultrasound 1 | 302/302 | No blinding | |||
| Ultrasound 2 | 626/626 | ||||
| Landmark | 66/302 (p<0.001) | ||||
| Complication rates (p<0.001): | |||||
| Ultrasound1/Ultrasound2/LM | Carotid puncture | ||||
| 8/8/25 | |||||
| Brachial Plex | |||||
| Injury | |||||
| 1/3/5 | |||||
| Haematoma | |||||
| 0/2/10 | |||||
| Total number attempts | |||||
| Ultrasound1 | 1.2±0.5, | ||||
| Ultrasound2 | 1.4±0.9 | ||||
| Landmark | 2.5±2.7 (p<0.001) | ||||
| First attempt success | |||||
| Ultrasound1 | 248 | ||||
| Ultrasound2 | 473 | ||||
| Landmark | 116 (p<0.001) | ||||
| Gualtieri et al18 1995 | 33 patients 53 placements RCT | SC CVC insertion in ICU patients | Success rate | No blinding. | |
| Operators with <30 procedures. | Ultrasound | 23/25 | Initial power calculation ignored and trial stopped when significance reached. | ||
| Landmark | 12/27 (p = 0.0003) | Group overlap: experienced operator intervened in 2 cases | |||
| Complication rate | |||||
| Ultrasound | 1/25 | ||||
| Landmark | 11/27 (p = 0.002) | ||||
| Total number attempts | |||||
| Ultrasound | 1.4 | ||||
| Landmark | 2.5 (p = 0.0007) | ||||
| CVC kit usage | |||||
| Ultrasound | 1.0 | ||||
| Landmark | 1.4 (p = 0.0003) | ||||
| Slama et al19 1997 | 79 RCT | IJ CVC insertion | Success rate | No power calculation. | |
| ICU patients by Junior doctors | Ultrasound | 37/37 | No blinding | ||
| Landmark | 32/42 (p<0.01) | ||||
| Time to insertion | |||||
| Ultrasound | 95±174 sec | ||||
| Landmark | 235±408 (p = 0.06;NS) | ||||
| Complication rate | |||||
| No sig. difference | |||||