ARISE

Population

• Patients presenting to the emergency department with early septic shock.

Intervention

Early goal-directed therapy.

Comparator

Usual care.

Key results

• 90-day mortality: 18.6% with EGDT vs 18.8% with usual care; absolute risk difference -0.3 percentage points (95% CI -4.1 to 3.6; p=0.90).
• In the first 6 hours, the EGDT group received more intravenous fluid (1964±1415 ml vs 1713±1401 ml).
• EGDT patients were more likely to receive vasopressors (66.6% vs 57.8%), red-cell transfusion (13.6% vs 7.0%), and dobutamine (15.4% vs 2.6%).
• Survival time, in-hospital mortality, duration of organ support, and hospital length of stay did not differ.

Harms

• EGDT increased early use of vasopressors, red-cell transfusion, and dobutamine without a survival benefit.

Practice impact

• Supports timely septic-shock care without a mandatory EGDT protocol.

Applicability

• Most applicable to emergency-department patients with early septic shock treated in systems similar to the participating Australasian centers.

Limitations

• Usual care already reflected contemporary sepsis resuscitation, so the trial tested an incremental protocol rather than resuscitation versus no resuscitation.
• EGDT increased treatment intensity in the first 6 hours without changing organ-support duration or hospital stay.

Common misinterpretations

• ARISE refutes the mandatory EGDT bundle, not the value of early recognition, antibiotics, fluids, and source control.
• A negative result means usual care matched EGDT, not that septic-shock resuscitation is unimportant.