Systematic review and meta-analysis of arterial catheter failure rates in adult critical care settings

INTRODUCTION: Although there is an extensive body of literature on complications associated with central venous catheters, less is known about arterial catheter-related complications. This systematic review and meta-analysis aimed to quantify the incidence of arterial catheter-related complications and failure in intensive care. METHODS: Databases were searched for relevant randomised controlled trials and cohort studies that reported on arterial catheter-related complications and failure within the adult critical care setting. Two authors independently identified studies for full review, extracted data and completed quality assessments. Pooled estimates were calculated using random-effects models with the Freeman-Tukey double arcsine transformation. Certainty of evidence for each outcome was assessed using the GRADE framework. RESULTS: Thirty-nine studies (22 observational studies and 17 randomised controlled trials) comprising 19,018 arterial catheters, were included. The pooled proportion of all-cause arterial catheter failure was 13.0% (95%CI 7.6-19.5%, moderate certainty). Non-infectious arterial catheter failure occurred in 19.8% (95%CI 12.2-28.7%, moderate certainty) of arterial catheters. The pooled proportion of all-cause catheter-associated or related bloodstream infections was 1.3% (95%CI 0.7-2.1%, moderate certainty). Local infection occurred in 1.2% (95%CI 0.4-2.4%, high certainty). Reporting of definitions of bloodstream and local infections was limited. Incidence density could not be calculated for any outcomes due to limited reporting of total catheter days. DISCUSSION: Arterial catheter failure occurs in up to one in five catheters in intensive care. Reducing failure rates and associated complications requires system-wide interventions, clearer definitions of infection and standardised reporting to improve data synthesis and guide evidence-based improvement.