TY - JOUR
T1 - Australasian resuscitation of sepsis evaluation (ARISE)
T2 - a multi-centre, prospective, inception cohort study
AU - Peake, Sandra L.
AU - Bailey, Michael
AU - Bellomo, Rinaldo
AU - Cameron, Peter A.
AU - Cross, Anthony
AU - Delaney, Anthony
AU - Finfer, Simon
AU - Higgins, Alisa
AU - Jones, Daryl A.
AU - Myburgh, John A.
AU - Syres, Gillian A.
AU - Webb, Steven A. R.
AU - Williams, Patricia
AU - ARISE Investigators, for the Australian and New Zealand Intensive Care Society Clinical Trials Group
A2 - Cooper, D. J.
A2 - Nevill, R.
A2 - Jacobs, S.
A2 - McArthur, C.
A2 - Newby, L.
A2 - Bell, J.
A2 - Conley, S.
A2 - Goldsmith, D.
A2 - Mercer, Inga
A2 - O'Sullivan, K.
A2 - Hawker, F.
A2 - Mitchell, I.
A2 - Bailey, A.
A2 - Henderson, S.
A2 - Mehrtens, J.
A2 - Bersten, A.
A2 - Ryan, E.
A2 - O'Callaghan, M.
A2 - Jenkins, I.
A2 - Palermo, A.
A2 - MacDonald, E.
A2 - Orford, N.
A2 - Flintoff, W.
A2 - Vibert, J.
A2 - McCalman, C.
A2 - McLennan, M.
A2 - Parr, M.
PY - 2009/7
Y1 - 2009/7
N2 - 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.
AB - 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.
KW - Critical illness
KW - Sepsis
KW - Early goal-directed therapy
KW - Resuscitation
KW - Mortality
KW - Emergency department
U2 - 10.1016/j.resuscitation.2009.03.008
DO - 10.1016/j.resuscitation.2009.03.008
M3 - Article
C2 - 19467755
SN - 1873-1570
VL - 80
SP - 811
EP - 818
JO - Resuscitation
JF - Resuscitation
IS - 7
ER -