Authors: Levy MM et al., Crit Care Med 2014 Oct 1;
An analysis of a large database shows a 25% relative mortality risk reduction in institutions with high versus low compliance with sepsis performance bundles.
The Surviving Sepsis Campaign (SSC) has led to early identification and treatment of patients with sepsis. Using the SSC’s database, investigators analyzed the association between compliance with resuscitation and management bundles and mortality at 218 community, academic, and tertiary care hospitals in the U.S., Europe, and South America. The study included 29,470 patients who met criteria for severe sepsis and septic shock over 7.5 years.
Each hospital was categorized as high or low compliance based on whether the percentage of patients who achieved all bundle elements was higher or lower than the median for all study hospitals (medians were 15% for the resuscitation bundle and 20% for the management bundle). Mortality was lower at hospitals that had high compliance with the resuscitation bundle (29.0% vs. 38.6%) and, less dramatically, at those that had high compliance with the management bundle (32.3% vs. 33.8%). For every 10% increase in compliance with the resuscitation bundle, length of stay in both the hospital and intensive care unit decreased by 4%.
These results are comparable to those of a prior study (NEJM Journal Watch Infect Dis Jul 23 2013). However, the ARISE trial affirmed that the real key is early identification of patients with sepsis and initiation of appropriate resuscitation (NEJM Journal Watch Emerg Med Oct 1 2014). It is likely that the better outcomes in the guideline-compliant hospitals reflected better overall care, and not specifically adherence to the bundle, particularly because bundle compliance, overall, was disappointingly low.