• Gerben Keijzers, Stephen Pj 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 McD Taylor, Patricia Williams, and the ARISE FLUIDS Observational Study Group.
• Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
• Emerg Med Australas. 2020 Aug 1; 32 (4): 586-598.

ObjectivesTo describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension.MethodsThis 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.ResultsA 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%).ConclusionCurrent 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.© 2020 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

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