Peripheral vs Central Access for Vasopressors: What Did the VIPCA Trial Find?

Study Overview

The VIPCA trial (Vasopressor Infusion via Peripheral Cannula vs Central Access) was a single-centre, randomised, controlled feasibility study conducted in a Queensland ICU. Forty critically ill adult patients requiring vasopressor infusions were randomised to receive either:

• Early CVC insertion (within 4 hours), or
• Delayed CVC insertion (after 12 hours), with initial infusion via a peripheral IV cannula (PIVC).

The aim was to determine whether a larger, definitive trial comparing these two approaches was feasible, particularly in terms of protocol adherence, recruitment, safety, and clinical outcomes.

Key Findings

• Protocol adherence was 100% in the late CVC group, but only 55% in the early CVC group, suggesting difficulty with timely central line insertion in a real-world ICU setting.
• PIVCs were largely safe, with a 20% minor complication rate (e.g., leakage, tissuing), but no serious adverse events (e.g., necrosis or need for surgery).
• The primary clinical outcome, Days Alive and Out of Hospital at Day 30 (DAH-30), was slightly higher in the late CVC group (median 19 days) compared to the early group (13.5 days), though this was not statistically significant.
• No CVC complications were recorded in the study.
• Most patients in the late CVC group continued on peripheral vasopressors without escalation, highlighting potential for safely avoiding CVCs in select patients.

Implications

This trial raises important questions about standard ICU practice. Can PIVC-delivered vasopressors be a safer, faster, and more resource-friendly alternative to early CVC placement in some patients?

While the feasibility of a larger trial was challenged by recruitment and adherence limitations, this study supports growing evidence that peripheral vasopressor delivery can be safe in the right setting. A multicentre, larger-scale trial is now warranted to assess outcomes more robustly and possibly redefine central line necessity in early shock management.

Read more: linkinghub.elsevier.com/retrieve/pii/S1441277225000109 

Authors: 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