Should Arterial Lines Remain Routine in Shock? A Nursing Viewpoint
TL;DR
The EVERDAC trial challenges routine placement, showing that in critically ill patients with shock, deferring arterial catheterization and using initial noninvasive monitoring with an automated brachial cuff was noninferior to early invasive monitoring for 28-day mortality.
Abstract
Abstract: Arterial lines remain a mainstay in intensive care units for continuous blood pressure monitoring (figure 1), frequent arterial blood sampling including blood gases, connection to pulse contour analysis devices for advanced hemodynamic parameters such as stroke volume, cardiac output, and pulse pressure variation, and guidance during cardiopulmonary resuscitation. The EVERDAC trial by Muller et al. challenges routine placement, showing that in critically ill patients with shock, deferring arterial catheterization and using initial noninvasive monitoring with an automated brachial cuff was noninferior to early invasive monitoring for 28-day mortality (34.3% versus 36.9%; adjusted risk difference, −3.2 percentage points; 95% CI, −8.9 to 2.5). Strikingly, only 14.7% of patients in the noninvasive group required later arterial line insertion, while the invasive group experienced higher rates of hematoma or hemorrhage (8.2% versus 1.0%). Device-related pain or discomfort was slightly more common in the noninvasive group (13.1% versus 9.0%), but secondary outcomes, including Sequential Organ Failure Assessment score evolution, ventilator-free days, and 90-day mortality (42.7% versus 44.0%), showed no significant differences.