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 P.J. 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 Mc D. Taylor; Patricia Williams; 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

Gerben Keijzers^*, Stephen P.J. 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 Mc D. Taylor, Patricia Williams, ARISE FLUIDS Observational Study Group

^*Corresponding author for this work

Faculty of Health Sciences & Medicine

Research output: Contribution to journal › Article › Research › peer-review

23 Citations (Scopus)

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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.

Original language	English
Pages (from-to)	586-598
Number of pages	13
Journal	EMA - Emergency Medicine Australasia
Volume	32
Issue number	4
Early online date	10 Feb 2020
DOIs	https://doi.org/10.1111/1742-6723.13469
Publication status	Published - 1 Aug 2020

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Keijzers, G., Macdonald, S. P. J., Udy, A. A., Arendts, G., Bailey, M., Bellomo, R., Blecher, G. E., Burcham, J., Coggins, A. R., Delaney, A., Fatovich, D. M., Fraser, J. F., Harley, A., Jones, P., Kinnear, F. B., May, K., Peake, S., Taylor, D. M. D., Williams, P., & ARISE FLUIDS Observational Study Group (2020). 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. EMA - Emergency Medicine Australasia, 32(4), 586-598. https://doi.org/10.1111/1742-6723.13469

@article{4065130eb9f046448c4cdd557b960bd9,

title = "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.",

author = "Gerben Keijzers and Macdonald, {Stephen P.J.} and Udy, {Andrew A.} and Glenn Arendts and Michael Bailey and Rinaldo Bellomo and Blecher, {Gabriel E.} and Jonathon Burcham and Coggins, {Andrew R.} and Anthony Delaney and Fatovich, {Daniel M.} and Fraser, {John F.} and Amanda Harley and Peter Jones and Kinnear, {Frances B.} and Katya May and Sandra Peake and Taylor, {David Mc D.} and Patricia Williams and {ARISE FLUIDS Observational Study Group}",

year = "2020",

month = aug,

day = "1",

doi = "10.1111/1742-6723.13469",

language = "English",

volume = "32",

pages = "586--598",

journal = "Emergency Medicine",

issn = "1742-6723",

publisher = "Wiley-Academy",

number = "4",

}

Keijzers, G, Macdonald, SPJ, Udy, AA, Arendts, G, Bailey, M, Bellomo, R, Blecher, GE, Burcham, J, Coggins, AR, Delaney, A, Fatovich, DM, Fraser, JF, Harley, A, Jones, P, Kinnear, FB, May, K, Peake, S, Taylor, DMD, Williams, P & ARISE FLUIDS Observational Study Group 2020, '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', EMA - Emergency Medicine Australasia, vol. 32, no. 4, pp. 586-598. https://doi.org/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. / Keijzers, Gerben; Macdonald, Stephen P.J.; Udy, Andrew A. et al.
In: EMA - Emergency Medicine Australasia, Vol. 32, No. 4, 01.08.2020, p. 586-598.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - 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

AU - Keijzers, Gerben

AU - Macdonald, Stephen P.J.

AU - Udy, Andrew A.

AU - Arendts, Glenn

AU - Bailey, Michael

AU - Bellomo, Rinaldo

AU - Blecher, Gabriel E.

AU - Burcham, Jonathon

AU - Coggins, Andrew R.

AU - Delaney, Anthony

AU - Fatovich, Daniel M.

AU - Fraser, John F.

AU - Harley, Amanda

AU - Jones, Peter

AU - Kinnear, Frances B.

AU - May, Katya

AU - Peake, Sandra

AU - Taylor, David Mc D.

AU - Williams, Patricia

AU - ARISE FLUIDS Observational Study Group

PY - 2020/8/1

Y1 - 2020/8/1

N2 - 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.

AB - 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.

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U2 - 10.1111/1742-6723.13469

DO - 10.1111/1742-6723.13469

M3 - Article

C2 - 32043315

AN - SCOPUS:85079453782

SN - 1742-6723

VL - 32

SP - 586

EP - 598

JO - Emergency Medicine

JF - Emergency Medicine

IS - 4

ER -

Keijzers G, Macdonald SPJ, Udy AA, Arendts G, Bailey M, Bellomo R et al. 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. EMA - Emergency Medicine Australasia. 2020 Aug 1;32(4):586-598. Epub 2020 Feb 10. 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

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