Left Versus Right Landmark-Guided Subclavian Cannulation in Cardiogenic Shock: A Retrospective Study in Myanmar

Background Rapid central venous access is essential in the management of cardiogenic shock. Although ultrasound-guided internal jugular vein cannulation is widely recommended, landmark-guided subclavian venous access remains necessary during emergency resuscitation when ultrasound guidance is not feasible. The optimal laterality for landmark-guided subclavian cannulation remains uncertain. Objectives Our Objectives are to compare the incidence of catheter malposition and complications between left- and right-sided landmark-guided subclavian venous cannulation in critically ill patients with cardiogenic shock in the coronary care unit. Methods We conducted a retrospective cohort study including 150 adult patients who underwent emergent landmark-guided subclavian venous catheterization in the coronary care unit. The primary outcome was catheter malposition confirmed by post-procedure chest radiography. Secondary outcomes included pneumothorax, arterial puncture, and hematoma formation. Results Among 150 patients, 72 underwent left-sided cannulation and 78 underwent right-sided cannulation. Catheter malposition occurred significantly more frequently following right-sided cannulation compared with left-sided cannulation (12.8% vs 2.8%; p = 0.03), corresponding to an approximately 4.6-fold higher risk of malposition. Mechanical complication rates were low and did not differ significantly between groups. Conclusions Right-sided landmark-guided subclavian cannulation was associated with a higher incidence of catheter malposition compared with the left-sided approach. The anatomical course of the left brachiocephalic vein may facilitate more reliable catheter placement during emergency central venous access.