Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Multi-centre, Randomised Controlled Trial of Early Goal-directed Therapy in Patients Presenting to the Emergency Department With Severe Sepsis in Australasia
Brief Summary: The ARISE RCT is a multi-centre, randomised, controlled trial of EGDT compared to standard care in patients with severe sepsis presenting to the ED. The study will be conducted in multiple sites with 1600 patients enrolled into the study.

Hypothesis to be tested: EGDT, compared to standard Australasian resuscitation practice, reduces 90-day all-cause mortality in patients presenting to the ED with severe sepsis.


Options:
A: Inclusion Criteria:

1. High-output shock
2. Cardiovascular SOFA score of \> 4
3. Cardiac Index \> 2.4 liters/min/BSA 1.73m2
4. Indwelling arterial line already present as part of standard care
5. Age \> 21 years of age
6. Signed consent form
7. Use of indwelling urinary catheter as standard care expected at least for 12 hours during the study interventions

Exclusion Criteria:

1. Patients with acute coronary syndrome
2. Patients with a known history of vasospasm
3. Patients with a history of asthma
4. Patients currently experiencing bronchospasm
5. Patients with active bleeding with an anticipated need for \> 4 units of PRBC or Hemoglobin \< 7g/dL or any other condition that would contraindicate drawing serial blood samples
B: Inclusion Criteria:

* Suspected or confirmed infection
* The presence of TWO or MORE of the following SIRS criteria:

  * Core temperature \< 36.0 degC or \> 38.0 degC
  * Heart rate \> 90 beats/minute
  * Respiratory rate \> 20 breaths/minute or PaCO2 \< 32 mmHg or the requirement for mechanical ventilation for an acute process
  * White blood cell count \> 12.0 or \< 4.0 x109/L or \> 10% immature band forms
* Evidence of either refractory hypotension OR hypoperfusion:

  * Refractory hypotension is confirmed by the presence of a systolic blood pressure (SBP) \< 90 mmHg or mean arterial pressure (MAP) \< 65 mmHg after a 1000ml intravenous (IV) fluid challenge within 60 minutes (including IV fluids administered pre-hospital)
  * Hypoperfusion is confirmed by the presence of a blood lactate concentration greater than or equal to 4.0 mmol/L
* First dose of IV antimicrobial therapy commenced prior to randomisation

Exclusion Criteria:

* Age \< 18 years
* Contra-indication to superior vena cava (SVC) CVC insertion
* Contra-indication to blood products (e.g. Jehovah's Witness)
* Inability to commence delivery of the EGDT protocol within 1 hour of randomisation or complete 6 hours of EGDT
* Haemodynamic instability due to active bleeding
* Pregnancy (confirmed or suspected)
* In-patient transfer from another acute health care facility
* An underlying disease process with a life expectancy of \< 90 days
* Death is deemed imminent and inevitable
* A "limitation of therapy" order has been documented restricting implementation of the study protocol or the treating clinician deems aggressive care unsuitable
C: Inclusion Criteria:

* Mean arterial pressure less than 70 mmHg or systolic pressure less than 100 mmHg persisting despite adequate fluid loading (in example with at least 1000 mL crystalloid or 500 ml colloid) unless central venous pressure (CVP) or pulmonary artery occluded pressure (PAOP) are elevated (e.g. CVP\> 12 mmHg or PAOP \> 14 mmHg).

Exclusion Criteria:

* Serious arrhythmia such as rapid atrial fibrillation (\> 160/min) or ventricular tachycardia.
* Brain death.
* Open label administration of dopamine, norepinephrine, epinephrine or phenylephrine for more than 4hours.
D: Inclusion Criteria:

* Clinical diagnosis of Septic shock
* Vasopressor support to maintain mean arterial pressure (MAP) between 65 and 75 mmHg despite adequate volume resuscitation (pulmonary artery occlusion pressure = 13-18 mmHg and central venous pressure = 8-12 mmHg)

Exclusion Criteria:

* Pregnancy
* Age \< 18 years
* Present cardiac dysfunction
* Present or suspected acute mesenteric ischemia

Answer: B