Hey folks, Scott Wygard here, and this is an M-Crit-We. Today, we're going to discuss the Everdack trial with its lead author.

So let me give you a quick summary of the trial. This was a really well-done trial. So randomized control, open-label, pragmatic trial in which patients are randomized to either receive an arterial line

catheter.

All right.

So over a thousand adult ICU patients admitted within 24 hours of shock, patients were

randomized one-to-one to either early invasive or non-invasive first.

Primary endpoint was all-cause mortality at 28

days. So the exclusion criteria. So if you could not place a brachial cuff or the breakle cuff was not

displaying a blood pressure, patients on ECMO, patients on high dose phase oppressors, but you might be like,

oh wow, then they didn't really test it.

Well, the doses that excluded the patients were crazy.

So they had to be above 1.2 micrograms per kilogram per minute of a combination of their

epidose and their norepidose, and most of that was nor epi, which means the patients had

to be on like 70 to 100 of nor epi to get excluded, patients with severe traumatic brain injury or patients whose BMI was

greater than 40. The 28-day mortality was basically the same. There was a non-inferior study.

There was a small amount of crossover. You could look at the study for that. There was safety criteria that caused

the non-invasive group to cross over. And one of them, the primary one that we'll talk about in

the show, is if they met that same safety threshold of those enormous doses of norEPI,

they finally would cross them over, I guess. If they're on 110 micrograms of norEPI, then

they'd cross them over.

There were more hematomas and bleeding from the arterial line catheters.

Obviously, there was a subjective assessment that the non-invasive cuff was more annoying when it was there versus the arterial line catheter.

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