A randomised, controlled, feasibility trial comparing vasopressors infused via peripheral cannula versus central venous access for critically ill adults: The VIPCA trial

Mahesh Ramanan; Yogesh Apte; Stacey Watts; Thomas Holland; April Hatt; Alison Craswell; Frances Lin; Alexis Tabah; Robert S. Ware; Joshua Byrnes; Christopher Anstey; Gerben Keijzers

doi:10.1016/j.ccrj.2025.100106

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A randomised, controlled, feasibility trial comparing vasopressors infused via peripheral cannula versus central venous access for critically ill adults: The VIPCA trial

Journal article

Open access

Peer reviewed

A randomised, controlled, feasibility trial comparing vasopressors infused via peripheral cannula versus central venous access for critically ill adults: The VIPCA trial

Mahesh Ramanan, Yogesh Apte, Stacey Watts, Thomas Holland, April Hatt, Alison Craswell, Frances Lin, Alexis Tabah, Robert S. Ware, Joshua Byrnes, …

Critical Care and Resuscitation, Vol.27(2), pp.1-8

2025

DOI: https://doi.org/10.1016/j.ccrj.2025.100106

PMCID: PMC12417211

PMID: 40933726

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Abstract

Cannula

Central line

Inotrope

Shock

Vasoactive

Vasopressor

Objective To determine the feasibility of conducting a definitive randomised trial to determine whether, in critically ill patients requiring intensive care unit admission, early CVC insertion compared with late CVC insertion leads to increased days-alive-and-out-of-hospital at 30 days (DAH-30) post-treatment. Design, settings and participants We conducted a single-centre, parallel-group, feasibility randomised controlled trial with critically ill patients receiving vasopressor infusions randomised in a 1:1 ratio to receive early CVC insertion (within 4 h) or late CVC insertion (after 12 h). All patients received vasopressor infusions via a peripheral intravenous cannula (PIVC) while awaiting CVC insertion. The primary clinical outcome was DAH-30 and the primary feasibility outcome was assessed by evaluating protocol adherence, rates of recruitment, randomisation of eligible patients, retention, follow-up and missing data. Results We enrolled 40 patients, 20 patients per group between January 2023 and May 2024. Protocol adherence was significantly lower in the early CVC group (55 %) compared to the late CVC group (100 %, p < 0.001). The early CVC group had a median time to CVC insertion of 3.3 h (interquartile range (IQR) 1.2–3.7 h), within the 4-h target. The early and late CVC groups had a median (IQR) of 13.5 (0.0–23.5) and 19.0 (5.0–23.0) DAH-30 respectively (P = 0.18). PIVC complications were similar between the two groups with no severe complications. There were no complications among the 18 CVCs inserted during the trial. Conclusions Protocol adherence in the early CVC was much lower than the late CVC. Some protocol modifications will be required to enable the conduct of a larger-scale definitive trial. Trial Registration ACTRN12621000721808 (Australia New Zealand Clinical Trials Registry).

Details

Title: A randomised, controlled, feasibility trial comparing vasopressors infused via peripheral cannula versus central venous access for critically ill adults: The VIPCA trial
Authors: Mahesh Ramanan (Corresponding Author) - Caboolture Hospital (Australia)
Yogesh Apte - Caboolture Hospital (Australia)
Stacey Watts - Caboolture Hospital (Australia)
Thomas Holland - Caboolture Hospital (Australia)
April Hatt - Caboolture Hospital (Australia)
Alison Craswell - University of the Sunshine Coast, Queensland, School of Health - Nursing
Frances Lin - University of the Sunshine Coast, Queensland, School of Health - Nursing
Alexis Tabah - Queensland University of Technology
Robert S. Ware - Griffith University
Joshua Byrnes - Griffith University
Christopher Anstey - Griffith University
Gerben Keijzers - Griffith University
Publication details: Critical Care and Resuscitation, Vol.27(2), pp.1-8
Publisher: Australasian Medical Publishing Company Pty. Ltd.
Date published: 2025
DOI: 10.1016/j.ccrj.2025.100106
PMID: 40933726; PMC12417211
Copyright note: © 2025 The Authors. Published by Elsevier B.V. on behalf of College of Intensive Care Medicine of Australia and New Zealand. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Data Availability: Deidentified data can be made available for sharing. To request data, please contact the corresponding author with a request. This will be reviewed by the trial management committee. Applications from investigators with suitable academic capability to conduct the proposed work will be considered. Approval from the ethics committee which approved the conduct of this trial will be required prior to sharing of any patient data. If a proposal is approved by the management committee and the ethics committee, a signed data transfer agreement will be required before data sharing.
Grant note: The VIPCA trial was funded by competitive grants received from The Common Good Foundation (Grant Number: CKW2022-02), Emergency Medicine Foundation (Grant Number: EMJS-411R372022-HOLLAND) and The University of Queensland Mayne Academy of Critical Care Pilot Study Grant.
Organisation Unit: Healthy Ageing Research Cluster; School of Health - Nursing
Language: English
Record Identifier: 991123749902621
Output Type: Journal article

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