title: Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study.
abstract: 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.
authors.affiliation: University of Adelaide, South Australia, Australia. sandra.peake@health.sa.gov.au
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Peake
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.forename: Anthony
authors.initials: A
authors.lastname: Cross
authors.forename: Anthony
authors.initials: A
authors.lastname: Delaney
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
authors.forename: Alisa
authors.initials: A
authors.lastname: Higgins
authors.forename: Daryl A
authors.initials: DA
authors.lastname: Jones
authors.forename: John A
authors.initials: JA
authors.lastname: Myburgh
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Syres
authors.forename: Steven A R
authors.initials: SA
authors.lastname: Webb
authors.forename: Patricia
authors.initials: P
authors.lastname: Williams
mesh_terms: 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*