The Australasian Resuscitation In Sepsis Evaluation: Fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Abstract

OBJECTIVES: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. METHODS: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. RESULTS: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87-100). Median time to first intravenous antimicrobials was 77 min (42-148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500-3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000-5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4-8.5%). CONCLUSION: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy.1742-6723Keijzers, Gerben <br />Orcid: 0000-0003-1100-4552 <br />Macdonald, Stephen Pj <br />Orcid: 0000-0001-9921-4620 <br />Udy, Andrew A <br />Orcid: 0000-0002-6284-2022 <br />Arendts, Glenn <br />Orcid: 0000-0001-7830-7756 <br />Bailey, Michael <br />Bellomo, Rinaldo <br />Blecher, Gabriel E <br />Orcid: 0000-0001-8537-2011 <br />Burcham, Jonathon <br />Coggins, Andrew R <br />Orcid: 0000-0002-5652-6920 <br />Delaney, Anthony <br />Orcid: 0000-0002-1015-7146 <br />Fatovich, Daniel M <br />Orcid: 0000-0001-9414-6905 <br />Fraser, John F <br />Harley, Amanda <br />Jones, Peter <br />Orcid: 0000-0003-1560-1186 <br />Kinnear, Frances B <br />May, Katya <br />Peake, Sandra <br />Taylor, David McD <br />Orcid: 0000-0002-8986-9997 <br />Williams, Patricia <br />the ARISE FLUIDS Observational Study Group <br />EMPJ-202R29-2018/Emergency Medicine Foundation/International <br />RGS20180020/Gold Coast Hospital Foundation Research Grant Scheme/International <br />Journal Article <br />Multicenter Study <br />Observational Study <br />Research Support, Non-U.S. Gov't <br />Emerg Med Australas. 2020 Aug;32(4):586-598. doi: 10.1111/1742-6723.13469. Epub 2020 Feb 10. <br />