ARISE Confirms ProCESS: Usual Care Is as Effective as EGDT in Septic Shock

The recent ProCESS trial, conducted at 31 U.S. academic centers, demonstrated that the specific monitoring strategies of early goal-directed therapy (EGDT) for septic shock did not provide any mortality benefit compared to protocol-based resuscitation or usual care (NEJM JW Emergency Medicine Mar 18 2014). Whether the ProCESS results were generalizable was not clear. In a collaborative study with a harmonized protocol — the ARISE trial — researchers at 51 tertiary and nontertiary sites in five countries randomized 1600 patients with early septic shock to EGDT or provider-directed usual care.

The primary ARISE endpoint of 90-day all-cause mortality was similar in the EGDT and usual-care groups (18.6% and 18.8%). Patients in the EGDT group rec…