Australasian resuscitation of sepsis evaluation (ARISE)

a multi-centre, prospective, inception cohort study

Sandra L. Peake, Michael Bailey, Rinaldo Bellomo, Peter A. Cameron, Anthony Cross, Anthony Delaney, Simon Finfer, Alisa Higgins, Daryl A. Jones, John A. Myburgh, Gillian A. Syres, Steven A. R. Webb, Patricia Williams, ARISE Investigators, for the Australian and New Zealand Intensive Care Society Clinical Trials Group

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Aim: Determine current resuscitation practices and outcomes in patients presenting to the emergency department (ED) with sepsis and hypoperfusion or septic shock in Australia and New Zealand (ANZ). 

Methods: Three-month prospective, multi-centre, observational study of all adult patients with sepsis and hypoperfusion or septic shock in the ED of 32 ANZ tertiary-referral, metropolitan and rural hospitals. 

Results: 324 patients were enrolled (mean [SD] age 63.4 [19.2] years, APACHE II score 19.0 [8.2], 52.5% male). Pneumonia (n=138/324, 42.6%) and urinary tract infection (n=98/324, 30.2%) were the commonest sources of sepsis. Between ED presentation and 6hours post-enrolment (T6hrs), 44.4% (n=144/324) of patients received an intra-arterial catheter, 37% (n=120/324) a central venous catheter and 0% (n=0/324) a continuous central venous oxygen saturation (ScvO(2)) catheter. Between enrolment and T6hrs, 32.1% (n=104/324) received a vasopressor infusion, 7.4% (n=24/324) a red blood cell transfusion, 2.5% (n=8/324) a dobutamine infusion and 18.5% (n=60/324) invasive mechanical ventilation. Twenty patients (6.2%) were transferred from ED directly to the operating theatre, 36.4% (n=118/324) were admitted directly to ICU, 1.2% (n=4/324) died in the ED and 56.2% (n=182/324) were transferred to the hospital floor. Overall ICU admission rate was 52.4% (n=170/324). ICU and overall in-hospital mortality were 18.8% (n=32/170) and 23.1% (n=75/324) respectively. In-hospital mortality was not different between patients admitted to ICU (24.7%, n=42/170) and the hospital floor (21.4%, n=33/154). 

Conclusions: Management of ANZ patients presenting to ED with sepsis does not routinely include protocolised, ScvO(2)-directed resuscitation. In-hospital mortality compares favourably with reported mortality in international sepsis trials and nationwide surveys of resuscitation practices.

Original languageEnglish
Pages (from-to)811-8
Number of pages8
JournalResuscitation
Volume80
Issue number7
DOIs
Publication statusPublished - Jul 2009
Externally publishedYes

Keywords

  • Critical illness
  • Sepsis
  • Early goal-directed therapy
  • Resuscitation
  • Mortality
  • Emergency department

Fingerprint Dive into the research topics of 'Australasian resuscitation of sepsis evaluation (ARISE): a multi-centre, prospective, inception cohort study'. Together they form a unique fingerprint.

Cite this