S01E06 Managing Shock Without Arterial Lines: EVERDAC

In this PRISM Rounds journal club, we unpack EVERDAC (NEJM)—a multicenter noninferiority randomized trial (n=1,010) asking a deceptively simple ICU question: Do most adults with acute circulatory failure really need an early arterial line, or can we start with cuff-only blood pressure monitoring and “rescue” to an A-line only when safety criteria demand it?We break down the noninferiority design, the prespecified crossover triggers (including the very high vasopressor dose threshold and unit conventions), and what the results mean for real-world ICU workflows—nursing, RT, pharmacy, and trainees included. Bottom line: mortality was similar, while arterial line–site bleeding/hematoma was much lower with a cuff-first strategy—so it’s time to re-think our default threshold for invasive monitoring.Study (NEJM): https://www.nejm.org/doi/10.1056/NEJMoa2502136Editorial (NEJM): https://www.nejm.org/doi/10.1056/NEJMe2512006Norepinephrine-equivalent dosing reference (PubMed): https://pubmed.ncbi.nlm.nih.gov/33220576/Tags: Critical Care; ICU; Shock; Hemodynamics; Arterial Line; Blood Pressure Monitoring; Vasopressors; Norepinephrine; Epinephrine; Noninferiority Trial; Randomized Trial; NEJM; Journal Club; Evidence-Based Medicine; Nursing; Respiratory Therapy; Pharmacy; Fellows; Residents; PRISM Rounds