Safety and Sustainability of Axillary Versus Radial Arterial Catheters in Critically Ill Children
A Retrospective Comparative Study
Pediatric Anesthesia
Submitted August 2025 by Dr Eamonn Upperton
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This retrospective cohort study examines axillary arterial lines placed in PICU patients to compare their safety profile with radial arterial lines, and provides some baseline data to support their use as a second line option.
Methods
Analysis
The limitations imposed by the retrospective cohort study design make it challenging to directly compare the two techniques:
- The axillary arterial line is described as an 'alternative access site' chosen by the clinician when catheterisation of the radial artery was not possible
- The axillary artery cohort was therefore not random, and likely consists of sicker patients with more difficult arterial access; 306 such patients were identified from the electronic record over a 15 year period
- The radial artery cohort was matched by similar age but otherwise randomly selected from the electronic record; 306 matched cases were selected
The cohorts were clearly quite different, as demonstrated by the 10% mortality rate in the axillary group compared with 2% in the radial group. It is therefore difficult to make conclusions about the safety of one technique compared with the other.
Looking at the outcomes examined:
- Primary outcome:
Discussion
Take home message
The purpose of this paper is to help the clinician faced with an unwell paediatric patient with difficult arterial access, and provides some reassurance that an axillary arterial line is a feasible option in those challenging circumstances.
The question of whether femoral or axillary artery is safer was not examined in this paper; this is likely to be
The description of an ischaemic limb experienced by a patient in the axillary artery cohort
