Australasian Resuscitation In Sepsis Evaluation Randomised Controlled Trial
- Conditions
- Severe Sepsis
- Interventions
- Other: Early Goal Directed Therapy (EGDT)
- Registration Number
- NCT00975793
- Lead Sponsor
- Belinda Howe
- Brief Summary
The ARISE RCT is a multi-centre, randomised, controlled trial of EGDT compared to standard care in patients with severe sepsis presenting to the ED. The study will be conducted in multiple sites with 1600 patients enrolled into the study.
Hypothesis to be tested: EGDT, compared to standard Australasian resuscitation practice, reduces 90-day all-cause mortality in patients presenting to the ED with severe sepsis.
- Detailed Description
The primary aim of the study is to determine whether providing EGDT, compared to standard care, reduces 90-day mortality in patients presenting to the ED of hospitals in Australasia with severe sepsis.
Each patient meeting all of the exclusion criteria and none of the exclusion criteria will be randomised in the ED to receive either EGDT for a total of 6 hours post-randomisation, or standard care.
Patients assigned to receive EGDT will be cared for by the dedicated ARISE study team. The patient will receive treatment as per the study protocol for 6 hours with central blood oxygen levels as the target end-point, then receive standard care.
Patients assigned to receive standard care will continue to be cared for by the hospital team in accordance with current best practice.
Patients in both groups will also receive any additional treatment needed, such as antibiotics or surgery.
This study will involve 1600 patients with severe sepsis admitted to the ED from multiple hospitals.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 1600
-
Suspected or confirmed infection
-
The presence of TWO or MORE of the following SIRS criteria:
- Core temperature < 36.0 degC or > 38.0 degC
- Heart rate > 90 beats/minute
- Respiratory rate > 20 breaths/minute or PaCO2 < 32 mmHg or the requirement for mechanical ventilation for an acute process
- White blood cell count > 12.0 or < 4.0 x109/L or > 10% immature band forms
-
Evidence of either refractory hypotension OR hypoperfusion:
- Refractory hypotension is confirmed by the presence of a systolic blood pressure (SBP) < 90 mmHg or mean arterial pressure (MAP) < 65 mmHg after a 1000ml intravenous (IV) fluid challenge within 60 minutes (including IV fluids administered pre-hospital)
- Hypoperfusion is confirmed by the presence of a blood lactate concentration greater than or equal to 4.0 mmol/L
-
First dose of IV antimicrobial therapy commenced prior to randomisation
- Age < 18 years
- Contra-indication to superior vena cava (SVC) CVC insertion
- Contra-indication to blood products (e.g. Jehovah's Witness)
- Inability to commence delivery of the EGDT protocol within 1 hour of randomisation or complete 6 hours of EGDT
- Haemodynamic instability due to active bleeding
- Pregnancy (confirmed or suspected)
- In-patient transfer from another acute health care facility
- An underlying disease process with a life expectancy of < 90 days
- Death is deemed imminent and inevitable
- A "limitation of therapy" order has been documented restricting implementation of the study protocol or the treating clinician deems aggressive care unsuitable
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Early Goal Directed Therapy Early Goal Directed Therapy (EGDT) Randomised allocation of early goal-directed therapy (EGDT).
- Primary Outcome Measures
Name Time Method The primary outcome measure for the study is death from all causes 90 days
- Secondary Outcome Measures
Name Time Method Death from all causes 28 days, and at ICU and hospital discharge Quality of life as measured by the SF-36v2, EQ-5D and the AQoL 6 and 12 months post-randomisation Duration of ED, ICU and hospital stay 28 days and 90 days The need for, and duration of, artificial organ support 28 days and 90 days
Trial Locations
- Locations (51)
Box Hill Hospital
🇦🇺Box Hill, Victoria, Australia
Royal Melbourne Hospital
🇦🇺Parkville, Victoria, Australia
Helsinki University Hospital
🇫🇮Helsinki, Finland
Tampere University Hospital
🇫🇮Tampere, Finland
The Alfred
🇦🇺Prahan, Victoria, Australia
Nepean Hospital
🇦🇺Penrith, New South Wales, Australia
Townsville Hospital
🇦🇺Douglas, Queensland, Australia
Hornsby Hospital
🇦🇺Hornsby, New South Wales, Australia
Port Macquarie Base
🇦🇺Port Macquarie, New South Wales, Australia
Canberra Hospital
🇦🇺Garran, Australian Capital Territory, Australia
Westmead Hospital
🇦🇺Westmead, New South Wales, Australia
Gosford Hospital
🇦🇺Gosford, New South Wales, Australia
The Queen Elizabeth Hospital (HK)
ðŸ‡ðŸ‡°Kowloon,, Hong Kong
Central Gippsland (Sale Hospital)
🇦🇺Sale, Victoria, Australia
Christchurch Hospital
🇳🇿Christchurch, New Zealand
Royal Prince Alfred Hospital
🇦🇺Camperdown, New South Wales, Australia
Coffs Harbour Hospital
🇦🇺Coffs Harbour, New South Wales, Australia
Royal North Shore Hospital
🇦🇺Sydney, New South Wales, Australia
Liverpool Hospital
🇦🇺Sydney, New South Wales, Australia
Royal Adelaide Hospital
🇦🇺Adelaide, South Australia, Australia
St Vincent's Hospital (Melbourne)
🇦🇺Fitzroy, Victoria, Australia
Royal Perth Hospital
🇦🇺Perth, Western Australia, Australia
Joondalup Health Campus
🇦🇺Joondalup, Western Australia, Australia
Sir Charles Gairdner Hospital
🇦🇺Nedlands, Western Australia, Australia
Sydney Adventist hospital
🇦🇺Sydney, New South Wales, Australia
Prince of Wales Hospital (Sydney)
🇦🇺Randwick, New South Wales, Australia
Tamworth Hospital
🇦🇺Tamworth, New South Wales, Australia
Manly Hospital
🇦🇺Manly, New South Wales, Australia
St Vincent's Hospital (Sydney)
🇦🇺Darlinghurst, New South Wales, Australia
John Hunter Hospital
🇦🇺Newcastle, New South Wales, Australia
Ipswich Hospital
🇦🇺Ipswich, Queensland, Australia
Royal Brisbane and Women's Hospital
🇦🇺Herston Brisbane, Queensland, Australia
Logan Hospital
🇦🇺Meadowbrook, Queensland, Australia
Toowoomba Hospital
🇦🇺Toowoomba, Queensland, Australia
The Queen Elizabeth Hospital
🇦🇺Adelaide, South Australia, Australia
Princess Alexandra
🇦🇺Woolloongabba, Queensland, Australia
Lyell McEwin Hospital
🇦🇺Elizabeth Vale, South Australia, Australia
Modbury Hospital
🇦🇺Modnury, South Australia, Australia
Bendigo Hospital
🇦🇺Bendigo, Victoria, Australia
Blacktown Hospital
🇦🇺Blacktown, Victoria, Australia
Dandenong Hospital
🇦🇺Dandenong, Victoria, Australia
Monash Medical Centre
🇦🇺Clayton, Victoria, Australia
Western Hospital
🇦🇺Footscray, Victoria, Australia
Frankston Hospital
🇦🇺Frankston, Victoria, Australia
Geelong Hospital
🇦🇺Geelong, Victoria, Australia
Austin Hospital
🇦🇺Melbourne, Victoria, Australia
Middlemore Hospital
🇳🇿Otahuhu AUCKLAND, Auckland, New Zealand
St. Vincent's University hospital
🇮🇪Dublin, Ireland
Auckland City Hospital
🇳🇿Auckland, New Zealand
Prince of Wales Hospital
ðŸ‡ðŸ‡°Hong Kong, Hong Hong, Hong Kong
Pamela Youde Nethersole Eastern Hospital (HK)
ðŸ‡ðŸ‡°Chai Wan, Hong Kong