Jul 2026· Critical Care & Emergency Medicine· Vol 6· 0 citations
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.
Autonomous or semi‑autonomous "autonomous vascular access" (AVA) platforms have the promise to standardize technique, accelerate placement by a wider range of providers, extend cannulation capability to austere settings, and reduce complication‑related morbidity.
Joel Grunhut, Patrick Walker, Meredith Lackie et al.· Military Medicine· 0 citations
Both devices provided effective hemodynamic support during cardiac arrest in the catheterization laboratory, and although Corpuls produced greater increases in diastolic and MAP from baseline, no clear device superiority was demonstrated.
U. Sajjad, R. Simpson, G. Movio et al.· ASAIO journal (1992)· 0 citations
Background: Intraoperative hypotension during major abdominal surgery is common and can result from changes in preload, afterload, or myocardial contractility. Recognising the underlying cause is essential for targeted haemodynamic management. Arterial dP/dtmax has been proposed as a surrogate marker for ventricular systolic function, but its behaviour during fluid and vasopressor administration under general anaesthesia remains not fully understood. This study evaluated changes in radial arterial dP/dtmax following protocol-guided fluid administration and norepinephrine boluses during intraoperative hypotension. Methods: This prospective observational study involved 88 adult patients undergoing elective major abdominal surgery with continuous radial arterial waveform monitoring. Hypotensive episodes were defined as a mean arterial pressure <65 mmHg persisting for at least 60 s and were managed according to a predefined algorithm based on stroke volume variation and dynamic arterial elastance. The primary outcome was the change in arterial dP/dtmax from baseline to 5 min after fluid administration. Linear mixed-effects models were used to account for repeated intervention episodes within patients. Results: A total of 502 protocol-guided intervention episodes contributed by 76 patients were included in the primary analysis: 228 fluid-treated episodes and 274 norepinephrine-treated episodes. Estimated mean arterial dP/dtmax increased from 517 mmHg·s−1 (95% CI 477–557) at baseline to 631 mmHg·s−1 (95% CI 591–671) at 5 min during fluid-treated episodes and from 575 mmHg·s−1 (95% CI 536–615) to 647 mmHg·s−1 (95% CI 608–686) during norepinephrine-treated episodes (both p < 0.001). A significant intervention-condition-by-time interaction was observed (F = 5.55, p = 0.019), indicating that temporal evolution of arterial dP/dtmax differed between the two algorithm-defined haemodynamic conditions. Conclusions: Radial arterial dP/dtmax increased after both fluid administration and norepinephrine, confirming its sensitivity to haemodynamic loading conditions. It should therefore be interpreted as an integrated haemodynamic variable influenced by ventricular performance, preload, and arterial properties rather than as a direct measure of intrinsic myocardial contractility.
Andrea Russo, Manuel Ignacio Monge García, A. Dell'Anna et al.· Journal of Clinical Medicine· 0 citations
This observational study evaluated the clinical utility of ultrasound-guided midline catheters (MCs) for the delivery of cardiovascular medications in the cardiovascular intensive care unit (CICU). Conducted at a tertiary hospital in China between 2020 and 2022, 387 critically ill CICU patients (median age 78 years) requiring multi-drug infusions were analysed. MCs demonstrated a median dwell time of 9 days (IQR: 6-13 days), successfully administering 13 cardiovascular medications, including vasopressors and antiarrhythmics. Complication rates were remarkably low (1.3%), with two lumen occlusions, two haemorrhages, and one phlebitis. No central line-associated bloodstream infections (CLABSIs) or symptomatic thromboses occurred. Compared to central venous catheters (CVCs), MCs reduced insertion complexity and infection risk while maintaining efficacy for prolonged therapy. The findings support MCs as a safe alternative to traditional CVCs in CICU settings, particularly for elderly patients with complex comorbidities. Nurses performed most insertions (78%), highlighting procedural accessibility. This study underscores the value of ultrasound-guided MCs in optimising vascular access strategies for critical cardiovascular care. Key Words: Midline catheter, Central venous catheter, Peripherally inserted central catheter, Cardiovascular intensive care unit.
Fen Xu, Tao Xiang, Li-Ang Zhang et al.· Journal of the College of Ph...· 0 citations
AIM
Advanced hemodynamic monitoring may provide clinical information during early post-resuscitation care after out-of-hospital cardiac arrest (OHCA), but practices, treatment targets, and responses to abnormal values remain incompletely defined. We aimed to map the available evidence on advanced hemodynamic monitoring after OHCA.
METHODS
We conducted a scoping review in accordance with a prespecified protocol and the PRISMA-ScR methodology. Eligible studies included hospitalized adults after OHCA and reported advanced hemodynamic variables beyond routine arterial blood pressure monitoring. We extracted data on study design, population, monitoring modality, variables assessed, hemodynamic targets or thresholds, treatment approaches, and reported associations with clinical outcomes.
RESULTS
Twenty-eight studies were included. The most frequently reported hemodynamic variables were cardiac output (27/28 studies), mean arterial pressure (MAP, 25/28), central venous pressure (17/28), and mixed venous oxygen saturation (SvO2, 14/28), whereas pulmonary vascular variables and pulmonary capillary wedge pressure were less commonly studied. Monitoring was predominantly invasive and most often based on pulmonary artery catheterization. Prognostic associations were heterogeneous: cardiac output showed inconsistent associations with outcomes, whereas low SvO2 and elevated pulmonary artery pressure were associated with worse outcomes in some studies. Hemodynamic targets were variably defined and were most frequently related to MAP-targets.
CONCLUSIONS
Advanced hemodynamic monitoring after OHCA remains heterogeneous, with a focus mainly on MAP and cardiac output. No single variable was consistently associated with prognosis or treatment response, although low SvO2 and elevated pulmonary artery pressure were associated with worse outcomes. Future studies should evaluate strategies integrating multiple hemodynamic variables and individualized patient-centred hemodynamic targets.
J. Grand, F. Lau, Christian Hassager et al.· Resuscitation· 0 citations
IntroductionContinuous invasive arterial blood pressure monitoring is the reference standard in the intensive care unit (ICU) for cardiovascular management. This study aimed to evaluate the safety of brachial arterial catheterization compared with radial and femoral approaches.MethodsA retrospective observational study of critically ill oncologic patients admitted to the ICU of Hospital SOLCA (Quito, Ecuador) between January 2021 and December 2023 was conducted. Data were extracted from the REDCap. Continuous variables were summarized as medians (IQR) and dichotomized at the median for regression analyses. Univariable logistic regression evaluated associations between clinical variables and catheter site (radial vs brachial). Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated, and statistical significance was defined as p < .05.ResultsA total of 305 arterial catheterizations were analyzed. Radial access was most frequently used (75.59%), followed by brachial (18.78%) and femoral (3.76%). In univariable analysis, admission priority III (OR 2.57, 95% CI 1.13-5.68; p = .02) and requiring two or more catheterization attempts (OR 11.50, 95% CI 4.81-29.20; p < .001) were significantly associated with catheter site. No vascular, infectious, or neurological complications were observed.ConclusionAdmission priority III and multiple attempts were significantly associated with catheter site selection. Brachial access demonstrated a safety profile comparable to radial and femoral sites, representing a valid alternative when radial cannulation is not feasible. Arterial catheterization in critically ill oncologic patients was safe, with very low complication rates. Prospective studies are warranted to confirm these findings.
Luis Unigarro, Emérita Basantes, Pablo Llerena et al.· Journal of Intensive Care Me...· 0 citations
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