Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study.
OBJECTIVE
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.
Peake
Sandra L
SL
University of Adelaide, South Australia, Australia. sandra.peake@health.sa.gov.au
Bailey
Michael
M
Bellomo
Rinaldo
R
Cameron
Peter A
PA
Cross
Anthony
A
Delaney
Anthony
A
Finfer
Simon
S
Higgins
Alisa
A
Jones
Daryl A
DA
Myburgh
John A
JA
Syres
Gillian A
GA
Webb
Steven A R
SA
Williams
Patricia
P
D000328:Adult; D000368:Aged; D044362:Australasia; D002985:Clinical Protocols; D015331:Cohort Studies; D003422:Critical Care; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012151:Resuscitation; D012772:Shock, Septic / Q000150:complications / Q000401:mortality / Q000628:therapy*