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

Gerben Keijzers; Stephen Pj Macdonald; Andrew A Udy; Glenn Arendts; Michael Bailey; Rinaldo Bellomo; Gabriel E Blecher; Jonathon Burcham; Andrew R Coggins; Anthony Delaney; Daniel M Fatovich; John F Fraser; Amanda Harley; Peter Jones; Frances B Kinnear; Katya May; Sandra Peake; David McD Taylor; Patricia Williams; the ARISE FLUIDS Observational Study Group

doi:10.1111/1742-6723.13469

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

Emerg Med Australas. 2020 Aug;32(4):586-598. doi: 10.1111/1742-6723.13469. Epub 2020 Feb 10.

Authors

Gerben Keijzers^{1

2

3}, Stephen Pj Macdonald^{4

5}, Andrew A Udy^{6

7}, Glenn Arendts⁸, Michael Bailey^{6

9}, Rinaldo Bellomo^{10

11}, Gabriel E Blecher^{12

13}, Jonathon Burcham^{4

5}, Andrew R Coggins¹⁴, Anthony Delaney^{6

15

16

17}, Daniel M Fatovich^{4

5}, John F Fraser^{18

19

20}, Amanda Harley^{1

21

22}, Peter Jones^{23

24}, Frances B Kinnear^{18

25}, Katya May¹, Sandra Peake^{26

27

28}, David McD Taylor^{29

30}, Patricia Williams^{26

27

28}; the ARISE FLUIDS Observational Study Group

Collaborators

the ARISE FLUIDS Observational Study Group:
Khanh Nguyen, Lai Heng Foong, Carolyn Hullick, Richard McNulty, Andrew Na, Christopher Trethewy, Lucy Lutze, Michael Zhang, Tim Cowan, Paul Middleton, Suzanne Avis, Sam Vidler, Mark Salter, Simon Janes, Anthony Delaney, Tom Harwood, Matthew Oliver, Farzad Jazayeri, Sarah Jones, Michael Davoren, Andrew Coggins, Bibhu Pradhananga, Peter Jones, Lynette Newby, Sierra Beck, Brad Sandleback, Sophie Rabas, Simon Harger, Eunicia Tan, Rima Song, Marc Gutenstein, Andrew Munro, Michael Connely, Jennifer Goodson, Alastair Mclean, Christine Brabyn, Saptarshi Mukerji, Harnah Simmonds, Paul Young, Yulia Sugeng, Cheryl Bird, Amanda McConnell, Gerben Keijzers, Peter Henderson, David Johnson, Siegfried Perez, Abbas Mahani, Ulrich Orda, Ogilvie Thom, Kym Roberts, Frances Kinnear, Sarah Hazelwood, Hanh Pham, Rob Eley, Georgia Livesay, Michael Devlin, Ian Murdoch, Erik Wood, Julian Williams, Nathan Brown, Alex King, Jan Sadewasser, Leonie Jones, Vinay Gangathimmaiah, Anit Manudhane, Daniel Haustead, Juan-Carlos Ascencio-Lane, David McD Taylor, Paul Buntine, Katie Walker, Pourya Pouryahya, Daniel Crompton, Ron Sultana, Timothy Campbell, Rosamond Dwyer, Gabriel Blecher, Jonathan Knott, Biswadev Mitra, Carl Luckhoff, Russel Young, Natalie Rudling, Ashes Mukherjee, Kerry-Lee Dyke, Casey Parker, Glenn Arendts, Alannah Cooper, Yusuf Nagree, Keng Koay, Coert Kruger, Nicole Ghedina, Ben Smedley, Jonathon Burcham, Stephen Macdonald, Helen Hamersley

Affiliations

¹ Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
² School of Medicine, Bond University, Gold Coast, Queensland, Australia.
³ School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
⁴ Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.
⁵ Emergency Department, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia.
⁶ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁷ Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia.
⁸ School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
⁹ Department of Medicine and Radiology, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
¹¹ School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
¹² Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.
¹³ Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
¹⁴ Emergency Medicine and Trauma, Westmead Hospital, Sydney, New South Wales, Australia.
¹⁵ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁶ Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
¹⁷ Division of Critical Care and Trauma, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.
¹⁸ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
¹⁹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
²⁰ Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia.
²¹ Critical Care Management Team, Queensland Children's Hospital, Brisbane, Queensland, Australia.
²² The University of Queensland, Brisbane, Queensland, Australia.
²³ School of Medicine, The University of Auckland, Auckland, New Zealand.
²⁴ Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
²⁵ Emergency and Children's Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
²⁶ Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
²⁷ Faculty of Health and Medical Sciences, School of Medicine, Adelaide University, Adelaide, South Australia, Australia.
²⁸ School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
²⁹ Emergency Medicine Research, Austin Hospital, Melbourne, Victoria, Australia.
³⁰ Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.

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.

Keywords: emergency department; fluid therapy; hypotension; sepsis; vasopressor.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Australien
Emergency Service, Hospital
Fluid Therapy
Humans
Middle Aged
Neuseeland
Prospective Studies
Resuscitation
Sepsis* / diagnosis
Sepsis* / drug therapy
Shock, Septic* / diagnosis
Shock, Septic* / drug therapy

Abstract

Publication types

MeSH terms

Grants and funding