AzTrials
AzTrials

Acute Circulatory FailureEVERDACNCT03680963

Early Versus Differed Arterial Catheterization in Critically Ill Patients With Acute Circulatory Failure:

A study testing Non-invasive strategy in people with Acute Circulatory Failure, run by University Hospital, Tours at 9 sites in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The objective of the present research is a combination of a one-sided test of non-inferiority and a one-sided test of superiority. A stepped approach will be used to evaluate these hypotheses: 1. Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
Acute Circulatory Failure
What is being tested?
Non-invasive strategy
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,010 participants
Where
9 sitesFrance
Study dates
15 Nov 2018to 28 Feb 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 18 years the day of inclusion
  • Existence of an acute circulatory failure defined by the presence of the following items 1 and 2:
  • Persisting hypotension (systolic blood pressure less than 90 mmHg or mean arterial blood pressure less than 65 mmHg) for more than 15 min at intensive care unit admission or within the following 24 hours, OR requirement of continuous intravenous vasopressor treatment (i.e. any dose of norepinephrine / epinephrine)
  • Presence at least one of the following signs of hypoperfusion: alteration of mental status; skin mottling; oliguria defined as a urine output < 0.5 mL/kg body weight for at least one hour; arterial lactate > 2 mmol/L; peripheral venous lactate > 3.2 mmol/L; ScvO2 <70%
  • Free express oral and informed consent of the patient or a proxy in case of impossibility for the patient to consent; emergency inclusion possible when legal representatives and patient's family are not available
  • French health insurance holder

Who cannot join

  • Acute circulatory failure, as defined by items 1 and 2 in inclusion criteria list (cf. supra) present for more than 24 hours
  • Non invasive blood pressure (NIBP) device fails to display a blood pressure value, or cuff placement impossible
  • Patient for whom an Extra-Corporeal Membrane Oxygenation (ECMO) therapy (either veno-arterial or venous-venous) is already in place or is to be initiated within the next 6 hours
  • Patient treated with vasopressor doses of more than 2.5 μg/kg/min of norepinephrine tartrate plus epinephrine for at least 2 hours (i.e., for instance, more than 8 mg of norepinephrine tartrate in 50 mL at the rate of 66 mL/hour for a patient weighing 70 kg) (please note that in fact this dosage corresponds to 1.25 μg/kg/min of norepinephrine base)
  • Severe traumatic brain injury (i.e., traumatic brain injury with a Glasgow coma scale score of less than 9 before sedation)
  • Patient previously included in the trial
Show all 11Show fewer
  • Body mass index (BMI) above 40 kg/m2
  • Pregnancy
  • Brain death
  • Moribund patient
  • Patient known, at time of inclusion, as being under guardianship, authorship or curators

Trial locations and contacts

9 sites in 1 country.

9 sites in 1 country

France9 sites
  • Intensive care

    Argenteuil

  • Intensive care

    Dijon

  • Intensive care

    La Roche-sur-Yon

  • Intensive care

    Montauban

  • Intensive care

    Nantes

  • Intensive care

    Orléans

  • Intensive care

    Poitiers

  • Intensive care

    Strasbourg

  • Intensive care

    Tours

Other trials in France

About this study

Official title: Early Versus Differed Arterial Catheterization in Critically Ill Patients With Acute Circulatory Failure: A Multicentre, Open-label, Pragmatic, Randomised, Non-inferiority Controlled Trial (EVERDAC Trial)

The objective of the present research is a combination of a one-sided test of non-inferiority and a one-sided test of superiority. A stepped approach will be used to evaluate these hypotheses:

  1. a less invasive intervention (i.e., no indwelling arterial catheter insertion until felt absolutely needed, according to consensual and predefined safety criteria) is non inferior to usual care (i.e., systematic indwelling arterial catheter insertion in the early hours of shock) in terms of mortality at day 28 (non-inferiority margin of 5%).
  2. a less invasive intervention is not only non-inferior but also superior to usual care in terms of mortality.

Multi-centre, pragmatic, randomised, controlled, open, two-parallel group, non-inferiority clinical trial.

Being tested
Non-invasive strategy, Control strategy
Medical subject headings
Shock

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Non-invasive strategyProcedure or surgery

    No indwelling arterial catheter insertion will be allowed during the first 28 days, excepted if predefined safety criteria (indicating absolute need of indwelling arterial catheter insertion) are reached.

    In the "non-invasive" group, automated oscillometric monitor will be used to monitor BP (blood pressure).

  • Control strategyProcedure or surgery

    An indwelling arterial catheter will be inserted as soon as possible (within the first four hours after randomization) and will be maintained except in case of indwelling arterial catheter futility, suspected or proven indwelling arterial catheter related infection or thrombosis (at discretion of attending physician) until day 28 or ICU (Intensive Care Unit) discharge (whichever comes first). After day 28, clinicians may choose to maintain or to remove indwelling arterial catheter.

Study groups in NCT03680963
Study groupRoleWhat they receive
Non-invasive strategyExperimentalNon-invasive strategy consisting of blood pressure monitoring by non-invasive automated cuff measurements
Receives: Procedure: Non-invasive strategy
Control strategyOtherUsual strategy of systematic indwelling arterial catheter insertion in the early hours of acute circulatory failure
Receives: Procedure: Control strategy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. All-cause mortality by 28 days after randomisation

    Measured: Patients will be followed from randomization to day 28

Secondary outcomes (36)
  1. To account for the potential bias brought by deaths occurring as the result of life-sustaining treatments withdrawal/withholding, as frequently encountered in intensive care unit, the investigators will record such events

    Measured: From inclusion to Day 35

  2. Cumulative incidence of death

    Measured: From inclusion through Day 90

  3. Cumulative survival free of indwelling arterial catheter insertion

    Measured: From inclusion through Day 90

  4. Number of patients who underwent indwelling arterial catheter insertion, in both groups

    Measured: From randomization to Day 28

  5. Evolution of daily Sequential Organ Failure Assessment (SOFA) score

    The score (ranged from 0 to 24, the worth outcome) is based on six sub-scores (each ranged from 0 to 4, the worth outcome), one for each respiratory system, neurological, cardiovascular, hepatic, renal and coagulation.

    Measured: During the first seven days

  6. Daily amount of intravenous fluid given for rapid vascular volume expansion

    Measured: From Day 1 to Day 7

  7. Duration of mechanical ventilation

    Measured: From inclusion to Day 28

  8. Ventilator-free days

    Patients dying between randomisation and Day 28 will be assigned a 0 value; for survivors at Day 28, all the days free of invasive mechanical ventilation through an endotracheal tube within the 28-day period will be taken into account

    Measured: From Day 1 to Day 28

  9. Proportion of patients treated by renal-replacement therapy

    Measured: Between Day 1 and Day 28

  10. Renal replacement therapy-free days

    Days without renal replacement therapy from Day 1 to Day 28 for survivors at Day 28, and from Day 1 to the date of death for patients dying before Day 28, will be taken into account

    Measured: From Day 1 to Day 28

  11. Proportion of patients treated by vasopressor

    Measured: Between Day 1 and Day 28

  12. Vasopressor therapy-free days

    Days without vasopressor therapy from Day 1 to Day 28 for survivors at Day 28, and from Day 1 to the date of death for patients dying before Day 28, will be taken into account

    Measured: From Day 1 to Day 28

  13. Mean daily blood volume drawn for lab testing during intensive care unit stay

    Measured: From inclusion to Day 28

  14. Number of blood cultures performed during intensive care unit stay

    Measured: From inclusion to Day 28

  15. Number of attempts at arterial puncture during intensive care unit stay

    Measured: From inclusion to Day 28

  16. Evolution of blood haemoglobin level

    Measured: From Day 1 to Day 28

  17. Evolution of haematocrit

    Measured: From Day 1 to Day 28

  18. Number of red blood cell packs transfused

    Measured: From Day 1 to Day 28

  19. Number of transcutaneous arterial and venous puncture for lab tests, arterial catheter insertion and set up of monitor, blood drawing from the arterial catheter or other vascular line

    Measured: From inclusion to Day 28

  20. Time (min) spent by nurses and physicians (min) on these tasks

    This outcome measure is planned to be collected during the first three days in a random sample of 10% of the study population and will be only considered during the medico-economic analyses.

    Measured: During the first three days of the intensive care unit stay

  21. Number of arterial and central venous catheter insertion during intensive care unit stay

    Expressed as the incidence of new cases per 1000 catheter-days, including local and catheter-related bloodstream infections as consensually defined.

    Measured: From inclusion to Day 28

  22. Numbers of arterial and central venous catheter-related infections

    Number of new cases per 1000 catheter-days

    Measured: During intensive care unit stay

  23. Numbers of local infections of arterial and central venous

    Number of new cases per 1000 catheter-days

    Measured: During intensive care unit stay

  24. Numbers of arterial and central venous catheter-related bloodstream infections

    Number of new cases per 1000 catheter-days

    Measured: During intensive care unit stay

  25. Number of bloodstream infections

    Measured: During intensive care unit stay

  26. Duration of intensive care unit stay

    Measured: From inclusion to discharge

  27. Duration of hospital stay

    Measured: From inclusion to discharge

  28. Intensive care unit mortality

    Measured: From inclusion to discharge

  29. Hospital mortality

    Measured: From inclusion to discharge

  30. Day 90 mortality

    Measured: Day 90

  31. Number of Adverse Events of special interest

    Measured: From inclusion to Day 90

  32. Incremental Cost-Effectiveness Ratio

    Measured: At Day 28

  33. Budget impact analysis of the generalization of the non-invasive strategy

    The budget impact analysis will be to multiply the average annual cost per patient over 5 years by the number of eligible patients, taking into account a penetration rate

    Measured: on a 5 years' time frame

  34. Pain related to the device used for blood pressure monitoring

    Numerical scale assessment of patient-reported pain related to the device used for blood pressure monitoring.

    Using the following 11-point numerical scales, ranged from 0 (no pain) to 10 (very important and permanent pain).

    Measured: Once a day, from inclusion to Day 28

  35. Discomfort related to device used for blood pressure monitoring

    Numerical scale assessment of patient-reported discomfort related to the device used for blood pressure monitoring Using the following 11-point numerical scales, ranged from 0 (no discomfort) to 10 (very important and permanent discomfort).

    Measured: One a day, from inclusion to Day 28

  36. Daily fluid balance of intakes and loss

    Difference between the daily amounts of:

    • daily fluid administration (in milliliter): intravenous hydration, vascular filling, enteral hydration
    • and the daily fluid loss (in milliliter): urine and fluid removal (during renal replacement therapy), tube drainage, estimated blood loss (laboratory test, bleeding)

    Measured: The first seven days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Sep 2018
  2. Study start15 Nov 2018
  3. Primary completion29 Nov 2022
  4. Study completion28 Feb 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,010 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03680963
Sponsor's protocol ID
DR180137
Acronym
EVERDAC
Status last verified
Apr 2025
First submitted
11 Sep 2018
Last updated
22 Dec 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Muller G, Contou D, Ehrmann S, Martin M, Andreu P, Kamel T, Boissier F, Azais MA, Monnier A, Vimeux S, Chenal A, Nay MA, Salmon Gandonniere C, Lascarrou JB, Roudaut JB, Plantefeve G, Giraudeau B, Lakhal K, Tavernier E, Boulain T; CRICS-TRIGGERSEP F-CRIN Network and the EVERDAC Trial Group. Deferring Arterial Catheterization in Critically Ill Patients with Shock. N Engl J Med. 2025 Nov 13;393(19):1875-1888. doi: 10.1056/NEJMoa2502136. Epub 2025 Oct 29.

    PubMed 41159885
  • Muller G, Kamel T, Contou D, Ehrmann S, Martin M, Quenot JP, Lacherade JC, Boissier F, Monnier A, Vimeux S, Brunet Houdard S, Tavernier E, Boulain T. Early versus differed arterial catheterisation in critically ill patients with acute circulatory failure: a multicentre, open-label, pragmatic, randomised, non-inferiority controlled trial: the EVERDAC protocol. BMJ Open. 2021 Sep 14;11(9):e044719. doi: 10.1136/bmjopen-2020-044719.

    PubMed 34521655

Questions about this trial

What is this clinical trial studying?

A study testing Non-invasive strategy in people with Acute Circulatory Failure, run by University Hospital, Tours at 9 sites in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 9 sites in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

All-cause mortality by 28 days after randomisation (time frame: Patients will be followed from randomization to day 28). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03680963, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Dec 2025; AzTrials last refreshed its copy on 2 Nov 2026.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in