EGDT or ProCESS , That is the question!

Infectious Disease PGY1 PGY2 PGY3 PGY4
NEJM published The ProCESS study. Basically, this study aimed to challenge EGDT by Manny Rivers in 2001, a very prestigious and novel approach to septic patient in ED. The EGDT was ED based approach. although some of the components were very difficult to acheived in ED such as Scvo2. The EGDT study showed 16% reduction in mortality, but Rivers faced lots of questions including feasibility of this approach in ED, and necessity of blood transfusion and etc… The whole concept was to have better oxygen delivery to tissue!
The ProCESS study published in NEJM this month enrolled 1351 patients from  March 2008 through May 2013  lead by the University of Pittsburgh. Patients were assigned to one of the 3 groups:
1. protocol-based EGDT: mainly Rivers protocol
2. protocol-based standard therapy: less aggressive approach: blood transfusion at Hb 7.5 and no mandatory central line access, etc
3. usual care: community based approach, they let providers take care of patient without any prompt or protocol
the study conclusion is :
They found no significant advantage, with respect to mortality or morbidity, of protocol-based resuscitation over bedside care that was provided according to the treating physician’s judgment.
The Rivers concept that we should remember and nobody can challenge is :
early resuscitation
early recognition of patient’s pathology
early oxygenation
Volume(IVF, or Blood transfusion)
early treatment(Abx)
Hospital Admission
and this is all we do in ED: Cath attack, Brain attack, Trauma activation, all have good outcomes because they are EGDT. We all know if you see a patient and order early cardiac monitor, o2 , IV … you will have a better understanding of patient, I believe we should do EGDT as our approach to every single patient regardless of  disease process and symptom/sign.  The concept of EGDT should stay with us regardless being true in sepsis or not!
Don’t forget to practice EARLY and GOAL DIRECTED in EM!