Today’s podcast references:
Deferring Arterial Catheterization in Critically Ill Patients with Shock [PubMed Abstract ]. Published October 29, 2025. N Engl J Med 2025;393:1875-1888. DOI: 10.1056/NEJMoa2502136. VOL. 393 NO. 19
Today, I review, link to, and embed EM Note ‘s “Deferring Arterial Catheterization in Critically Ill Patients with Shock” .
All that follows is from the above resource.
VIDEO Deferring Arterial Catheterization in Critically Ill Patients with Shock
EM Note
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The EVERDAC Trial:
Non-Invasive vs. Invasive Monitoring Clinical trial changing ICU care. Patients have shock. Blood pressure dangerously low. Doctors need real-time data. Standard way: invasive catheter. Invasive method has serious risks. Alternative: simple arm cuff. Arm cuff way safer. Question: is the risky catheter needed for every patient?
Trial Design and Strategy
Randomized noninferiority trial used. Over 1000 patients were split up. Trial compared two methods head-to-head. Goal: prove the cuff is not worse (non-inferior). Invasive strategy: early arterial catheter insertion. Noninvasive strategy: automated brachial cuff monitoring. 1010 patients underwent randomization. Arterial catheter insertion was allowed later in noninvasive group if needed.
Primary Outcome – Survival
Primary outcome was death from any cause at Day 28. Survival rates were almost exactly the same. The arm cuff was officially non-inferior. Management without early catheter was non-inferior to early insertion. 34.3% died in noninvasive group (173 patients). 36.9% died in invasive group (185 patients). Risk difference was -3.2 percentage points.
Complications and Adverse Events
Complications show massive difference. Hematoma or hemorrhage related to device recorded. Invasive catheter group had over 8% of patients with bleeding issues. Specifically, 8.2% had hematoma or hemorrhage in invasive group. Simple arm cuff group plummeted to 1% for bleeding issues.
Complications and Adverse Events
Serious bloodstream infections were almost 3% for invasive group. Infections were way down, less than 1%, for non-invasive group. Pain or discomfort recorded. More pain reported in noninvasive group (13.1%) than invasive group (9.0%).
Future Implications
This means three huge implications for patient treatment. Invasive approach might not be necessary for most patients in shock. The simple arm cuff did not put patients at greater risk. Makes you wonder what other standard practices should be questioned.
