Arterial Measurement Sites for Hemodynamic Management

(IPAMS Trial)

Overseen By Pascal Laferriere-Langlois, MD, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ciusss de L'Est de l'Île de Montréal

Disqualifiers: Severe vascular disease, Arterial gradient, Allergies, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 7

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines the best way to measure blood pressure during major abdominal surgeries. It compares the standard radial artery method (near the wrist) with the brachial artery method (closer to the body's center), which might provide a more accurate reading. The researchers aim to determine if the measurement site affects the amount of medication used to maintain blood pressure and to explore whether AI can predict the best method to use. Individuals scheduled for major abdominal surgery lasting over two hours might be suitable for this study. As an unphased trial, it offers participants the chance to contribute to innovative research that could enhance surgical outcomes.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these arterial measurement techniques are safe for hemodynamic management during surgeries?

Research has shown that using either radial or brachial arterial lines during surgeries is generally safe. Studies indicate that serious complications occur in less than 1% of cases for both types, making major issues rare.

Some studies found higher death rates and longer ICU stays with the brachial line, possibly because patients were already very sick and required this type of monitoring.

For the radial line, bleeding and bruising (a collection of blood outside a blood vessel) are common issues. However, using ultrasound during the procedure can enhance safety and increase the likelihood of success on the first attempt.

Overall, both methods are well-tolerated, and serious problems are uncommon. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it could redefine how we manage hemodynamic monitoring during surgeries. Traditionally, hemodynamic management relies on the radial artery for monitoring blood pressure and guiding treatment decisions. This trial is comparing the use of the brachial artery as an alternative monitoring site. The brachial artery might provide more accurate or reliable data due to its larger size and proximity to the heart, which could lead to more precise management of a patient's blood pressure and overall stability during surgeries. If successful, this could enhance patient outcomes by providing anesthesiologists with a potentially more effective tool for monitoring and intervention.

What evidence suggests that this trial's methods of arterial pressure measurement could be effective for hemodynamic management during major abdominal surgeries?

This trial will compare two methods of hemodynamic management: brachial artery-guided interventions and radial artery-guided interventions. Studies have shown that using a catheter in the upper arm (brachial artery) during surgeries can provide a more accurate picture of blood pressure near the heart. This method is often chosen because it offers continuous blood pressure information with a lower risk of complications. In this trial, some participants will have their hemodynamic management guided by the brachial arterial line.

Conversely, using a catheter in the wrist (radial artery) is the standard method. It is known for reliable blood pressure monitoring and easy access for taking blood samples. However, the wrist method might not always reflect blood pressure near the heart as accurately as the upper arm method. In this trial, other participants will have their hemodynamic management guided by the radial arterial line. Both methods are crucial for monitoring blood pressure during surgery, but the upper arm method might offer a clearer understanding of overall blood pressure. ^{1 2 6 7 8}

Are You a Good Fit for This Trial?

Adults scheduled for elective major abdominal surgeries who meet the study's criteria can join this trial. It aims to see if where we measure blood pressure during surgery affects how much medicine is used to keep blood pressure stable.

Inclusion Criteria

I have had major surgery in my abdomen with general anesthesia.

My surgery is expected to last more than 2 hours under anesthesia.

Exclusion Criteria

I have severe blood vessel disease in my arms.

Significant arterial gradient between arms with preoperative non-invasive blood pressure measurements (>25 mm Hg of systolic blood pressure or 10 mm Hg of mean arterial pressure)

Known allergies, intolerance, other medical conditions that preclude the use of prescribed general anesthesia protocol for this trial

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intraoperative Monitoring

Participants undergo arterial pressure monitoring using radial and brachial lines during major abdominal surgeries. Hemodynamic management is guided by either radial or brachial arterial lines depending on the group.

Duration of surgery

1 visit (in-person)

Post-operative Monitoring

Participants are monitored for post-operative complications and recovery, including fluid balance, noradrenaline administration, and other hemodynamic parameters.

7 days

3 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including evaluation of post-operative complications and lab measurements.

7 days

3 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Brachial line catheterization
• Brachial line guided hemodynamic management
• Radial line catheterization
• Radial line guided hemodynamic management

Trial Overview The trial tests two ways of monitoring blood pressure in surgery: using a radial artery line (usual method) or a brachial artery line (could be more accurate). Patients are randomly chosen to get one method, and doctors use that data to decide on fluid and drug management without knowing which method is being used.

How Is the Trial Designed?

Group I: Brachial artery-guided interventions Experimental Treatment 3 Interventions

In this experimental group, hemodynamic management will be guided by using the brachial arterial line. Both a radial and a brachial line will be inserted for simultaneous monitoring, but the anesthesiologist will only see the brachial arterial line and will guide his drug administration and hemodynamic management on the brachial measurements.

Group II: Radial artery-guided interventions Active Control 3 Interventions

In this group, hemodynamic management will be guided by using the radial arterial line. Both a radial and a brachial line will be inserted for simultaneous monitoring, but the anesthesiologist will only see the radial arterial line and will guide his drug administration and hemodynamic management on the brachial measurements.

Who Is Running the Clinical Trial?

Ciusss de L'Est de l'Île de Montréal

Lead Sponsor

Trials

81

Recruited

6,400+

Fonds de la Recherche en Santé du Québec

Collaborator

Trials

84

Recruited

46,700+

Fondation Anesthesiologistes du Quebec

Collaborator

Citations

1. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK499989/

Arterial Lines - StatPearls - NCBI Bookshelf - NIH Arterial lines are crucial for continuous hemodynamic monitoring and frequent arterial blood sampling in critically ill and perioperative ...

2. medrxiv.org medrxiv.org/content/10.1101/2025.11.02.25339344v1.full.pdf

Importance of arterial measurement sites for intraoperative ... only one blinded catheter will guide intraoperative hemodynamic management. ... arterial line to clinical staff while maintaining complete data ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10814054/

Patient and Technical Factors Associated with Difficult Arterial ... Arterial catheterization enables continuous hemodynamic monitoring but has been shown to cause severe complications, especially when ...

4. jacc.org jacc.org/doi/10.1016/j.jchf.2024.03.020

Practical Guidance for Hemodynamic Assessment by Right ... This review is a field guide for hemodynamic assessment, troubleshooting, and interpretation for clinicians treating patients with heart failure.

5. hospitalprocedures.org hospitalprocedures.org/brachial-arterial-catheterization-and-its-low-risk-of-complications/

Brachial Arterial Catheterization & Its Low Risk of ... Brachial arterial catheterization is widely chosen for constant blood pressure and hemodynamic monitoring in critically ill patients.

6. sciencedirect.com sciencedirect.com/science/article/abs/pii/S105307702400106X

Hemodynamic Monitoring In The Cardiac Surgical Patient The present study compared 3 different arterial line procedures. It is hypothesized that a 20-G 12.7- cm catheter inserted into the radial artery will be equal ...

7. journals.sagepub.com journals.sagepub.com/doi/abs/10.1177/0003134820964211

Complications Following Brachial Arterial Catheterization ... In summary, brachial arterial catheters were associated with high mortality and prolonged ICU length of stay. This likely reflects the ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC137445/

Complications and risk factors of peripheral arterial catheters ... Major complications occurred in fewer than 1% of the cases, and rates were similar for the radial, femoral and axillary arteries.