Distal radial artery approach for invasive blood pressure monitoring in intensive cardiac care unit

Abstract Background Direct intra-arterial pressure measurement is a mandatory step in hemodynamic assessment of patients admitted in intensive cardiac care unit (ICCU). The forearm radial artery (fRA) is considered the gold standard for this purpose. The distal radial artery (dRA) is a novel access site in interventional cardiology. Purpose We evaluated the use of dRA as an alternative approach to standard fRA for invasive blood pressure monitoring in ICCU. Methods This is a single-center, randomized, non-inferiority trial. Patients admitted in ICCU needing invasive blood pressure monitoring were randomly allocated to dRA or fRA access site (1:1 ratio). Primary endpoint was non-inferiority of dRA in catheterization success rate, using either anatomical approach (one attempt) or ultrasound-guided puncture (one attempt), with 15% as non-inferiority margin. Secondary endpoints were: first attempt success rate; arterial catheterization time; catheterization-related quality of pain; incidence of complications. Results A total of 250 patients were enrolled. The final catheterization success rate was 95.2% in the dRA arm vs 96.8% in the conventional fRA arm, with a mean difference of -1.6% favoring the latter approach (95%CI -6.5 to 3.3). The dRA approach for the primary endpoint of final catheterization success rate was non-inferior to the fRA approach (p-value for non-inferiority 0.001). First attempt success rates were 59.2% with dRA and 70.4% with fRA (p=0.12). There was no difference in arterial catheterization time and catheterization-related quality of pain between the two arms. Entry-site complications were reduced with dRA (6.7% vs 17.4% in the fRA group; p=0.013); this was mainly driven by a decreased incidence of hematoma (0.8% vs 6.6%; p=0.020). A numerically lower occurrence of arterial occlusion was observed with dRA (0.8% vs 5%; p=0.06). Conclusions This randomized study first indicates that the use of the dRA in ICCU patients is as effective as the conventional fRA for invasive blood pressure monitoring and may have greater safety. These results may support the implementation of the dRA approach also in the setting of ICCU patients.Distal radial artery catheterization Baseline, endpoints and complications