Comparison of Femoral and Internal Jugular Vein Cannulation for Rapid Resuscitation during Cardiopulmonary Arrest


  • Sanum Kashif Department of Anesthesia, Frontier Corps Hospital, Quetta Pakistan



Cannulation, Cardiopulmonary resuscitation (CPR), Catheterization, Femoral artery, Internal jugular artery


Objective: To compare Femoral and Internal jugular veins for rapid fluid and drug administration during ongoing
cardiopulmonary resuscitation.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Intensive Care Unit, Frontier Corps Hospital, Quetta Pakistan, from Aug 2019 to Jan 2020.
Methodology: After Ethical Committee Approval, 60 consecutive critical patients of ICU were inlcuded and divided into
Femoral and Internal Jugular Groups as per the catheterization they received during cardiopulmonary resuscitation. The
landmark technique was used in both groups. Success rate along with complications were compared between groups.

Results: In the Femoral (F) Group, cannulation was successful in 28 patients (93.3%) out of 30 patients, whereas in the Internal Jugular (I) Group, out of 30 patients, 22(73.3%) patients were successfully cannulated. Inadvertent carotid and femoral artery punctures occurred in 6 patients (20.0%) in the Internal Jugular-Group and one patient (3.3%) in the Femoral-Group, respectively. In contrast, soft tissue injury occurred due to more than one attempt in 5 patients (16.7%) in the Internal JugularGroup and two patients (6.7%) in the Femoral-Group.

Conclusion: The study concluded that femoral vein cannulation is superior to internal jugular cannulation for successful
resuscitation in critical care patients without disruption of chest compression and, therefore, should be the method of choice in these patients.


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Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, BergKM ,et al. Adult Basic and Advanced Life Support, Pediatric

Basic and Advanced Life Support, Neonatal Life Support,Resuscitation Education Science, and Systems of Care WritingGroups. Part 1: Executive summary: 2020 American HeartAssociation guidelines for cardiopulmonary resuscitation andemergency cardiovascular care. Circ Cardiovasc Interv2020;142(16_Suppl_2):337357.

Garg R, Ahmed SM, Kapoor MC, Rao SC, Mishra BB, KalandoorMV, et al. Comprehensive cardiopulmonary life support (CCLS)for cardiopulmonary resuscitation by trained paramedics andmedics inside the hospital. Indian J Anaesth 2017; 61(11): 883.

Daya MR, Leroux BG, Dorian P, Rea TD, Newgard CD,Morrison LJ, et al. Survival After Intravenous VersusIntraosseous Amiodarone, Lidocaine, or Placebo in Out-ofHospital Shock-Refractory Cardiac Arrest. Circ CardiovascInterv 2020; 141(3): 188-198.

Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF.Ultrasound guidance versus anatomical landmarks forsubclavian or femoral vein catheterization. Cochrane DatabaseSyst Rev 2015; 1(1): CD011447.

Shrestha GS, Gurung A, Koirala S. Comparison between longand short-axis techniques for ultrasound-guided cannulation ofinternal jugular vein. Ann Card Anaesth 2016; 19(2): 288.

Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al.European resuscitation council guidelines for resuscitation 2015:section 3. Adult advanced life support. Resuscitation 2015; 95(1):100-147.

Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP,Moitra VK ,et al. Part 7: adult advanced cardiovascular life

support: 2015 American Heart Association guidelines update forcardiopulmonary resuscitation and emergency cardiovascularcare. Open Circ Vasc J 2015; 132(18_suppl_2): S444-464.

Nassar BS, Kerber R. Improving CPR performance. Chest 2017;152(5): 1061-1069.

Raut MS, Arun M. Difficult venous catheterization in internaljugular vein. Ann Card Anaesth 2015; 18(1): 106-108.

Bourgeois SL. Central venous access techniques. Atlas OralMaxillofac Surg Clin North Am 2015; 23(3): 137-145.

Hodzic S, Golic D, Smajic J, Sijercic S, Umihanic S, Umihanic S, etal. Complications related to insertion and use of central venouscatheters (CVC). Med Arch 2014; 68(5): 300.

Akaraborworn O. A review in emergency central venouscatheterization. Chin J Traumatol 2017; 20(3): 137-140.

Georgiou M, Papathanassoglou E, Xanthos T. Systematic reviewof the mechanisms driving effective blood flow during adultCPR. Resuscitation 2014; 85(11): 1586-1593.

Beccaria PF, Silvetti S, Lembo R, Landoni G, Monti G, Zambon M, et al. The brachiocephalic vein as a safe and viable alternative tointernal jugular vein for central venous cannulation. AnesthAnalg 2018; 127(1): 146-150.

Butt MU, Gurley JC, Bailey AL, Elayi CS. Pericardial TamponadeCaused by Perforation of Marshall Vein During Left Jugular

Central Venous Catheterization. Am J Case Rep 2018 ; 19(1): 932-934.

Sidoti A, Brogi E, Biancofiore G, Casagli S, Guarracino F,Malacarne P, et al. Ultrasound-versus landmark-guided

subclavian vein catheterization: a prospective observationalstudy from a tertiary referral hospital. Sci Rep 2019; 9(1): 1-7.

Kastler A, Chabanne R, Azarnoush K, Cosserant B, Camilleri L,Boyer L, et al. Arterial injury complicating subclavian central

venous catheter insertion. J Cardiothorac Vasc Anesth 2012;26(1): 101-103.

Hamada SR, Fromentin M, Ronot M, Gauss T, Harrois A,Duranteau J, et al. Femoral arterial and central venous catheters

in the trauma resuscitation room. Injury 2018; 49(5): 927-932.

Dinh LD, Nguyen DH. Vascular access for hemodialysis: Currentpractice in Vietnam. J Vasc Access 2019; 20(1_suppl): 20-23.

Choi SJ, Lee SY, Ryeom HK, Kim GC, Lim JK, Lee SM, et al.Femoral versus jugular access for Denali Vena Cava Filter

placement: analysis of fluoroscopic time, filter tilt and retrievaloutcomes. Clin Imaging 2018; 52(2): 337-342.




How to Cite

Kashif, S. (2023). Comparison of Femoral and Internal Jugular Vein Cannulation for Rapid Resuscitation during Cardiopulmonary Arrest. Pakistan Armed Forces Medical Journal, 73(6), 1598–1601.



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