What the study found
Landmark-guided central venous access was reported as safe and effective in the authors' prehospital trauma setting. The authors argue that a universal requirement for real-time ultrasound guidance may not be suitable in time-critical emergencies.
What the authors say this matters
The authors conclude that, in prehospital trauma care, delays from preparing and using ultrasound may harm patients when rapid access is urgent. They suggest that guidance allowing clinician judgement in emergencies would better match real-world constraints while still supporting safety.
What the researchers tested
The article is a commentary on the Safe Vascular Access 2025 consensus statement, with discussion focused on recommendation six about real-time ultrasound guidance for central vein access. The authors also refer to their own cohort study of 346 prehospital central line insertions from 2019 to 2023.
What worked and what didn't
The authors report an 80% success rate and a 4% complication rate for landmark-guided central access, which they say is comparable with ultrasound-guided complication rates. They state that successful placement was strongly associated with higher prehospital transfusion volumes and higher rates of return of spontaneous circulation in traumatic cardiac arrest. They also note that ultrasound-guided access may be quicker or safer in some cases, and that clinicians in their service may use it when appropriate.
What to keep in mind
The abstract describes a specific prehospital trauma context, especially exsanguinating haemorrhagic shock and traumatic cardiac arrest, so the authors do not present their view as universal. The limitations of the cohort study are not described in the available summary.
Key points
- The authors argue that a blanket requirement for real-time ultrasound guidance may not fit prehospital trauma care.
- They report that landmark-guided central access had an 80% success rate and a 4% complication rate in 346 prehospital insertions.
- Successful placement was associated with higher transfusion volumes and more return of spontaneous circulation in traumatic cardiac arrest.
- The authors say ultrasound should be used whenever feasible, but clinician judgement may be needed when delay could endanger life.
Disclosure
- Research title:
- Landmark-guided central venous access remained safe in prehospital trauma
- Authors:
- Andrew Wood, Cosmo Scurr
- Institutions:
- London Ambulance Service NHS Trust
- Publication date:
- 2026-04-28
- OpenAlex record:
- View
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