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Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study

2009; Elsevier BV; Volume: 80; Issue: 7 Linguagem: Inglês

10.1016/j.resuscitation.2009.03.008

1873-1570

Sandra Peake, Michael Bailey, Rinaldo Bellomo, Peter Cameron, Anthony Cross, Anthony Delaney, Simon Finfer, Alisa M. Higgins, Daryl Jones, John Myburgh, Gillian Syres, S. A. R. Webb, Patricia Williams,

Respiratory Support and Mechanisms

Aim 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 6 hours 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 (ScvO2) 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, ScvO2-directed resuscitation. In-hospital mortality compares favourably with reported mortality in international sepsis trials and nationwide surveys of resuscitation practices.