• Alasdair J Gray, Katherine Oatey, Julia Grahamslaw, Sîan Irvine, John Cafferkey, Titouan Kennel, John Norrie, Tim Walsh, Nazir Lone, Daniel Horner, Andy Appelboam, Peter Hall, SkipworthRichard J ERJEClinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom., Derek Bell, Kevin Rooney, Manu Shankar-Hari, Alasdair R Corfield, and Albumin, Balanced, and Crystalloid-Sepsis (ABC-Sepsis) Investigators.
• Emergency Medicine Research Group, Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
• Crit. Care Med. 2024 Oct 1; 52 (10): 152015321520-1532.

ObjectivesInternational guidelines recommend IV crystalloid as the primary fluid for sepsis resuscitation, with 5% human albumin solution (HAS) as the second line. However, it is unclear which fluid has superior clinical effectiveness. We conducted a trial to assess the feasibility of delivering a randomized controlled trial comparing balanced crystalloid against 5% HAS as sole early resuscitation fluid in patients with sepsis presenting to hospital.DesignMulticenter, open, parallel-group randomized feasibility trial.SettingEmergency departments (EDs) in 15 U.K. National Health Service (NHS) hospitals.PatientsAdult patients with sepsis and a National Early Warning Score 2 greater than or equal to five requiring IV fluids withing one hour of randomization.InterventionsIV fluid resuscitation with balanced crystalloid or 5% HAS for the first 6 hours following randomization.Measurements And Main ResultsPrimary feasibility outcomes were recruitment rate and 30-day mortality. We successfully recruited 301 participants over 12 months. Mean ( sd ) age was 69 years (± 16 yr), and 151 (50%) were male. From 1303 participants screened; 502 participants were potentially eligible and 300 randomized to receive trial intervention with greater than 95% of participants receiving the intervention. The median number of participants per site was 19 (range, 1-63). Thirty-day mortality was 17.9% ( n = 53). Thirty-one participants died (21.1%) within 30 days in the 5% HAS arm, compared with 22 participants (14.8%) in the crystalloid arm (adjusted odds ratio, 1.50; 95% CIs, 0.84-2.83).ConclusionsOur results suggest it is feasible to recruit critically ill patients to a fluid resuscitation trial in U.K. EDs using 5% HAS as a primary resuscitation fluid. There was lower mortality in the balanced crystalloid arm. Given these findings, a definitive trial is likely to be deliverable, but the point estimates suggest such a trial would be unlikely to demonstrate a significant benefit from using 5% HAS as a primary resuscitation fluid in sepsis.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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