Australasian Resuscitation In Sepsis Evaluation Randomised Controlled Trial

NCT ID: NCT00975793

Last Updated: 2014-04-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

1600 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-10-31

Study Completion Date

2015-04-30

Brief Summary

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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

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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.

Conditions

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Severe Sepsis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Standard Care

Randomised allocation of standard care at the clinician's discretion in accordance with current best practice.

Group Type NO_INTERVENTION

No interventions assigned to this group

Early Goal Directed Therapy

Randomised allocation of early goal-directed therapy (EGDT).

Group Type EXPERIMENTAL

Early Goal Directed Therapy (EGDT)

Intervention Type OTHER

Randomised allocation of early goal-directed therapy (EGDT). EGDT involves treatment with intravenous fluids, and medications to support the blood pressure and heart following a protocol. A special catheter is inserted to monitor central blood oxygen levels and the standard treatments are given according to the blood oxygen level reading. EGDT is given for 6 hours, then the patient receives standard care.

Interventions

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Early Goal Directed Therapy (EGDT)

Randomised allocation of early goal-directed therapy (EGDT). EGDT involves treatment with intravenous fluids, and medications to support the blood pressure and heart following a protocol. A special catheter is inserted to monitor central blood oxygen levels and the standard treatments are given according to the blood oxygen level reading. EGDT is given for 6 hours, then the patient receives standard care.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* 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

Exclusion Criteria

* 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
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Australian and New Zealand Intensive Care Society Clinical Trials Group

NETWORK

Sponsor Role collaborator

Australasian College for Emergency Medicine

OTHER

Sponsor Role collaborator

Belinda Howe

OTHER

Sponsor Role lead

Responsible Party

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Belinda Howe

Project manager, ANZIC- Research Centre, Monash University

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Rinaldo Bellomo

Role: PRINCIPAL_INVESTIGATOR

Austin Hospital, Melbourne Australia

Sandra L Peake

Role: STUDY_CHAIR

The Queen Elizabeth Hospital

Locations

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Canberra Hospital

Garran, Australian Capital Territory, Australia

Site Status

Royal Prince Alfred Hospital

Camperdown, New South Wales, Australia

Site Status

Coffs Harbour Hospital

Coffs Harbour, New South Wales, Australia

Site Status

St Vincent's Hospital (Sydney)

Darlinghurst, New South Wales, Australia

Site Status

Gosford Hospital

Gosford, New South Wales, Australia

Site Status

Hornsby Hospital

Hornsby, New South Wales, Australia

Site Status

Manly Hospital

Manly, New South Wales, Australia

Site Status

John Hunter Hospital

Newcastle, New South Wales, Australia

Site Status

Nepean Hospital

Penrith, New South Wales, Australia

Site Status

Port Macquarie Base

Port Macquarie, New South Wales, Australia

Site Status

Prince of Wales Hospital (Sydney)

Randwick, New South Wales, Australia

Site Status

Royal North Shore Hospital

Sydney, New South Wales, Australia

Site Status

Liverpool Hospital

Sydney, New South Wales, Australia

Site Status

Sydney Adventist hospital

Sydney, New South Wales, Australia

Site Status

Tamworth Hospital

Tamworth, New South Wales, Australia

Site Status

Westmead Hospital

Westmead, New South Wales, Australia

Site Status

Townsville Hospital

Douglas, Queensland, Australia

Site Status

Royal Brisbane and Women's Hospital

Herston Brisbane, Queensland, Australia

Site Status

Ipswich Hospital

Ipswich, Queensland, Australia

Site Status

Logan Hospital

Meadowbrook, Queensland, Australia

Site Status

Toowoomba Hospital

Toowoomba, Queensland, Australia

Site Status

Princess Alexandra

Woolloongabba, Queensland, Australia

Site Status

The Queen Elizabeth Hospital

Adelaide, South Australia, Australia

Site Status

Royal Adelaide Hospital

Adelaide, South Australia, Australia

Site Status

Lyell McEwin Hospital

Elizabeth Vale, South Australia, Australia

Site Status

Modbury Hospital

Modnury, South Australia, Australia

Site Status

Bendigo Hospital

Bendigo, Victoria, Australia

Site Status

Blacktown Hospital

Blacktown, Victoria, Australia

Site Status

Box Hill Hospital

Box Hill, Victoria, Australia

Site Status

Monash Medical Centre

Clayton, Victoria, Australia

Site Status

Dandenong Hospital

Dandenong, Victoria, Australia

Site Status

St Vincent's Hospital (Melbourne)

Fitzroy, Victoria, Australia

Site Status

Western Hospital

Footscray, Victoria, Australia

Site Status

Frankston Hospital

Frankston, Victoria, Australia

Site Status

Geelong Hospital

Geelong, Victoria, Australia

Site Status

Austin Hospital

Melbourne, Victoria, Australia

Site Status

Royal Melbourne Hospital

Parkville, Victoria, Australia

Site Status

The Alfred

Prahan, Victoria, Australia

Site Status

Central Gippsland (Sale Hospital)

Sale, Victoria, Australia

Site Status

Joondalup Health Campus

Joondalup, Western Australia, Australia

Site Status

Sir Charles Gairdner Hospital

Nedlands, Western Australia, Australia

Site Status

Royal Perth Hospital

Perth, Western Australia, Australia

Site Status

Helsinki University Hospital

Helsinki, Finland, Finland

Site Status

Tampere University Hospital

Tampere, Finland, Finland

Site Status

Prince of Wales Hospital

Hong Kong, Hong Hong, Hong Kong

Site Status

Pamela Youde Nethersole Eastern Hospital (HK)

Chai Wan, Hong Kong, Hong Kong

Site Status

The Queen Elizabeth Hospital (HK)

Kowloon, Hong Kong, Hong Kong

Site Status

St. Vincent's University hospital

Dublin, , Ireland

Site Status

Middlemore Hospital

Otahuhu Auckland, Auckland, New Zealand

Site Status

Christchurch Hospital

Christchurch, New Zealand, New Zealand

Site Status

Auckland City Hospital

Auckland, , New Zealand

Site Status

Countries

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Australia Finland Hong Kong Ireland New Zealand

References

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Higgins AM, Peake SL, Rinaldo Bellomo AO, Ao DJC, Delaney A, Howe BD, Nichol AD, Webb SA, Williams PJ, Harris AH; ARISE Investigators and the ANZICS Clinical Trials Group. The cost-effectiveness of early goal-directed therapy: an economic evaluation alongside the ARISE trial. Crit Care Resusc. 2023 Oct 18;23(3):329-336. doi: 10.51893/2021.3.OA10. eCollection 2021 Sep 6.

Reference Type DERIVED
PMID: 38046082 (View on PubMed)

Higgins AM, Peake SL, Bellomo R, Cooper DJ, Delaney A, Harris AH, Howe BD, Nichol AD, Webb SA, Williams PJ; Australasian Resuscitation in Sepsis Evaluation (ARISE) Investigators and the ANZICS Clinical Trials Group. Quality of Life and 1-Year Survival in Patients With Early Septic Shock: Long-Term Follow-Up of the Australasian Resuscitation in Sepsis Evaluation Trial. Crit Care Med. 2019 Jun;47(6):765-773. doi: 10.1097/CCM.0000000000003762.

Reference Type DERIVED
PMID: 30985391 (View on PubMed)

ARISE Investigators; ANZICS Clinical Trials Group; Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014 Oct 16;371(16):1496-506. doi: 10.1056/NEJMoa1404380. Epub 2014 Oct 1.

Reference Type DERIVED
PMID: 25272316 (View on PubMed)

Delaney A, Peake SL, Bellomo R, Cameron P, Holdgate A, Howe B, Higgins A, Presneill J, Webb S; ARISE Investigators. Australasian Resuscitation In Sepsis Evaluation trial statistical analysis plan. Emerg Med Australas. 2013 Oct;25(5):406-15. doi: 10.1111/1742-6723.12116. Epub 2013 Sep 9.

Reference Type DERIVED
PMID: 24099368 (View on PubMed)

Other Identifiers

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NHMRC Project grant no. 491075

Identifier Type: -

Identifier Source: secondary_id

ANZIC - RC/RB001

Identifier Type: -

Identifier Source: org_study_id

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