Goal-Directed Resuscitation for Patients with Early Septic Shock (ARISE)

ARISE was one of three concurrent RCTs (with ProCESS and ProMISe) designed to test whether protocolized EGDT improved outcomes in septic shock compared to usual care.

Multicenter RCT (51 EDs in Australia/New Zealand/Finland/Hong Kong, n=1,600) comparing EGDT vs. usual care in early septic shock.

90-day mortality was identical: 18.6% EGDT vs 18.8% usual care (p=0.90). EGDT patients received more IV fluids, blood transfusions, and dobutamine. No difference in organ support or hospital length of stay.

Protocolized EGDT offers no benefit over usual care in septic shock. Together with ProCESS and ProMISe, ARISE confirmed that the key elements of sepsis care are early recognition, antibiotics, and adequate resuscitation — not specific hemodynamic targets.

Usual care had improved significantly since Rivers 2001. EGDT protocol may have been harmful in some patients (excess transfusions).