Arterial Catheters Don't Save Lives

"Change my mind."

My bias is obviously clear from just the title, although I come from an ED perspective rather than an ICU perspective. If this trial shows arterial catheterization can be deferred from a critical care standpoint, then these devices almost certainly have a much-reduced role in the ED. Mucking about with measurement devices distracts from the cognitive activities of resuscitation and diagnosis.

This latest trial comes from a group in the running for the Nobel Prize of Worst Acronym: the CRICS-TRIGGERSEP F-CRIN Network. They’ve put together a protocol in which arterial catheters are avoided, and blood pressure is measured non-invasively during admission to an ICU – and that even included removing arterial catheters if present on randomization. There were obviously exceptions and exclusions, as well as allowances for subsequent catheter insertion, but their intervention and survival curves looked like this:

There’s a lot of detail in the supplement regarding any impact on treatments, but it roughly appears both groups were managed similarly.

There was also another endpoint with respect to discomfort, with the idea that avoiding an arterial catheter would be desired by those hospitalized in the ICU. However, there were an excess of arterial blood draws in the deferred catheterization arm, and this measured as more problematic than the catheters themselves. The authors note they had a protocol in place to minimize such blood draws, but it was not adhered to rigorously. More effort would be needed to reduce such painful blood draws should catheter avoidance be implemented.