• Nobuaki Shime, Koji Hosokawa, and Graeme MacLaren.
• 1Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 2Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. 3Cardiothoracic ICU, National University Health System, Singapore. 4Paediatric ICU, Department of Paediatrics, The Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia.
• Pediatr Crit Care Me. 2015 Oct 1; 16 (8): 718-25.

ObjectiveUltrasound imaging has been shown to be beneficial for percutaneous central venous cannulation in systematic reviews of randomized controlled trials in adult patients, but not in pediatrics. The aim of this updated review was to determine whether percutaneous central venous catheterization with the aid of ultrasound reduces cannulation failure in children.Data SourcesPubMed was searched using the terms: ultrasound, catheterization, central vein (including internal jugular and femoral veins), and pediatrics.Study SelectionBoth nonrandomized comparative studies and randomized controlled trials were eligible for inclusion if they assessed the rate of cannulation failure using real-time, dynamic ultrasound guidance, ultrasound-assisted vein prelocation, and/or anatomic landmark technique.Data ExtractionFive nonrandomized studies and nine randomized controlled trials were included. The rates of cannulation failure and arterial puncture were retrieved.Data SynthesisRandom-effects meta-analysis was applied.ConclusionsThe meta-analysis of five nonrandomized studies showed that the rate of cannulation failure was significantly lower with real-time ultrasound guidance than anatomic landmark technique (odds ratio, 0.44 [95% CI, 0.27-0.72]; p = 0.001). The combination of nine randomized controlled trials also showed lower failure rates with either the real-time ultrasound guidance or the prelocation technique over the landmark technique (odds ratio, 0.22 [95% CI, 0.07-0.69]; p = 0.0003) and fewer arterial punctures in the ultrasound group (odds ratio, 0.31 [95% CI, 0.09-1.08]; p = 0.07). However, seven out of nine studies were assessed as having high risk of bias. Since the lower cannulation failure and less frequent chance of arterial puncture with ultrasound were predominantly shown in studies at high risk of bias, further definitive and adequately powered studies with clear outcomes are needed.

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