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SepsisPhase 3EVISNCT05179499

Early Vasopressors in Sepsis

A Phase 3 study testing Norepinephrine and Balanced Crystalloid in people with Sepsis, run by NHS Greater Glasgow and Clyde at 25 sites in United Kingdom.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Sepsis is a life-threatening reaction to an infection. It happens when the immune system overreacts to an infection and starts to damage the body's tissues and organs. The aim of this research study is to compare the two different ways to treat sepsis, in the early phase of treatment immediately after the participants… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Sepsis
What is being tested?
Norepinephrine and Balanced Crystalloid
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
1,006 participants
Where
25 sitesUnited Kingdom
Study dates
11 Oct 2022to Oct 2027
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age >18 years
  • Clinically suspected or proven infection resulting in principal reason for acute illness
  • SBP < 90 mmHg or MAP of < 65 mmHg (within an hour of eligibility assessment)
  • Measured serum lactate of > 2 mmol/L. The serum lactate should be measured 2 hours prior to determination of eligibility, where possible. Longer timeframes may be used and justified within the medical notes if, in the opinion of the investigator, the clinical status of the patient has not significantly improved in the time interval between lactate measurement and eligibility assessment. Lactate measurements more than 4 hours prior to eligibility assessment should not normally be used.
  • Hospital presentation within last 12 hours

Who cannot join

  • >1500ml of intravenous fluid prior to screening
  • Clinically judged to require immediate surgery (within one hour of eligibility assessment)
  • Immediate (< 1 hour) requirement for central venous access
  • Chronic renal replacement therapy
  • Known allergy/adverse reaction to norepinephrine
  • Palliation / end of life care (explicit decision by patient/family/carer in conjunction with clinical team that active treatment beyond symptomatic relief is not appropriate)
Show all 13Show fewer
  • Previous recruitment in the trial
  • Patients with permanent incapacity
  • Pregnancy. All women of childbearing potential (WoCBP) must have a negative urine or serum pregnancy test result completed as part of screening requirements.
  • WoCBP are defined as fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause.
  • Other primary causes of shock (e.g. suspected cardiogenic shock, haemorrhagic shock, etc)
  • History or evidence of any other medical, neurological or psychological condition that would expose the subject to an undue risk of a significant Adverse Effect as determined by the clinical judgement of the investigator
  • Participation in other clinical trials of investigational medicinal products

Trial locations and contacts

25 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Alasdair Corfield contact

Alasdair.corfield2@nhs.scot

25 sites in 1 country

United Kingdom25 sites, 21 recruiting
  • Aintree University Hospital

    Aintree

    Ben Morton

    Recruiting
  • Royal Blackburn Hospital

    Blackburn

    Terminated
  • Fairfield General Hospital

    Bury

    Scott Houston

    Recruiting
  • Addenbrookes Hospital, Cambridge

    Cambridge

    David Leverton

    Recruiting
  • Royal Derby Hospital

    Derby

    Andrew Tabner

    Recruiting
  • Royal Infirmary of Edinburgh

    Edinburgh

    Alasdair Gray

    Recruiting
  • Victoria Hospital

    Fife Keith

    Rajendra Raman

    Recruiting
  • Glasgow Royal Infirmary

    Glasgow

    Donogh Maguire

    Recruiting
  • Queen Elizabeth University Hospital

    Glasgow

    David Lowe

    Recruiting
  • Hull Royal Infirmary

    Hull

    Jack Preece

    Recruiting
  • Kettering General

    Kettering

    Maria iliescu

    Recruiting
  • University Hospital Crosshouse

    Kilmarnock

    Terminated
  • University Hospital Monklands

    Lanark

    Nicola Moultrie

    Recruiting
  • Leicester Royal Infirmary

    Leicester

    Terminated
  • Royal Liverpool University Hospital

    Liverpool

    Ned Gilbert-Kawai

    Recruiting
  • Newham University Hospital

    London

    Ben Bloom

    Emma Young

    Recruiting
  • Royal London Hospital

    London

    Ben Bloom

    Recruiting
  • St George's

    London

    Terminated
  • University Hospital Lewisham

    London

    anna colclough

    Recruiting
  • John Radcliffe Hospital

    Oxford

    Deon Louw

    Recruiting
  • Royal Alexandra Hospital

    Paisley

    Santosh Bongale

    Recruiting
  • Peterborough City Hospital

    Peterborough

    Christopher Edmunds

    Recruiting
  • Royal Berkshire Hospital

    Reading

    Matthew Frise

    Recruiting
  • Queens Hospital Barking

    Romford

    Darryl Wood

    Recruiting
  • Salford Royal

    Salford

    Daniel Horner

    Recruiting

Other trials in United Kingdom

About this study

Sepsis is a life-threatening reaction to an infection. It happens when the immune system overreacts to an infection and starts to damage the body's tissues and organs.

The aim of this research study is to compare the two different ways to treat sepsis, in the early phase of treatment immediately after the participants arrive in hospital. The standard approach is to give a salt solution fluid through a drip in the participants arm to start with, then adding in a medication that increases the blood flow to the participants vital organs (a vasopressor mediation called norepinephrine) if required. The alternative approach is to start the vasopressor medication immediately, and then add in extra salt solution fluid via a drip if required. Vasopressors work by increasing the blood pressure which allows a better blood flow to the internal organs. The investigators plan to see which approach is better and to see if they have a role in improving a patient's recovery time, reducing complications, the length of time they stay in hospital and longer term poor health.

Based on research that has already been done, the investigators believe treating patients with vasopressors when they arrive in the Emergency Department, may have potential advantages over the standard fluids used today. However, the evidence is not clear and that is why this research is being done.

Read the detailed description

Sepsis results from overwhelming reactions to microbial infections where the immune system initiates dysregulated responses that lead to remote organ dysfunction, shock and ultimately death. Sepsis remains a significant global issue - as well as direct mortality, survivors suffer long term reductions in patient centred outcomes, with reduced quality of life and functional status. Patients with hypotension and organ hypoperfusion as a result of sepsis have poorer outcomes by dysregulated inflammation, endothelial dysfunction, immune suppression, and organ dysfunction. Current guidelines highlight the importance of early fluid resuscitation, but the association of early fluid therapy with improved outcomes is unclear. In the resuscitation phase, current practice is to give intravenous (IV) fluid and intermittent vasopressor boluses if required, before, for some patients, continuous vasopressor infusion via a central venous line in Intensive Care (ICU). An alternative, early continuous peripheral vasopressor infusion (PVI) is not routine practice in the UK.

Current practice in the UK is guided by NICE Sepsis guidance and the international Surviving Sepsis Campaign (SSC) consensus recommendations. Both specify intravenous fluid administration as a central tenet of early resuscitation of patients with septic shock, with intravenous vasopressor administration recommended after intravenous fluid resuscitation. NICE recommend boluses of 500ml of crystalloid and "refer to critical care for review of management including need for central venous access and initiation of vasopressors". SSC recommend 30ml/kg crystalloid in first hour, followed by vasopressors to maintain MAP>65.

The current NICE fluid resuscitation guideline, November 2020, continues to emphasise 500ml boluses of crystalloid as usual care. A recent international survey of 100 critical care and EM physicians regarding intravenous fluid resuscitation practice, confirmed that an initial bolus of 1000ml of crystalloid, followed by 500ml boluses of crystalloid remained the most common management strategy for the initial treatment of septic shock. This persisted despite the lack of benefit demonstrated in three landmark trials of protocolised sepsis management.

In recent years, there has been increasing acceptance of peripheral administration of norepinephrine, based on evidence of safety and efficacy. The Intensive Care Society published guidance on peripheral vasopressor infusion in November 2020. We have recently conducted a survey amongst ED and ICU clinicians in the UK regarding attitudes and current practice related to the use of intravenous peripheral vasopressors. Eighty two respondents provided the following answers

  1. Experience of use of any intravenous vasopressor in ED was high (81%);
  2. Exclusive PVI made up 23% of all vasopressor use in ED;
  3. Norepinephrine (norepinephrine) was the most common vasopressor (54%);
  4. Barriers to PVI were local protocols and an appropriate level of care in the destination ward for a patient on vasopressor infusion.
Conditions
Sepsis
Being tested
Norepinephrine, Balanced Crystalloid
Keywords
Sepsis, Resuscitation, Norepinephrine, Intravenous fluids, Emergency Medicine, Critical Care
Medical subject headings
Sepsis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • NorepinephrineDrug

    Norepinepherine should be prepared and delivered at a concentration of 16 micrograms/ml

  • Balanced CrystalloidOther

    IV fluids administered as per standard care

Study groups in NCT05179499
Study groupRoleWhat they receive
Intervention ArmActive comparatorParticipants will receive peripheral vasopressor infusion of norepinephrine (16 micrograms/ml) during the initial 48 hour study period. All other care will be as per local protocol.
Receives: Drug: Norepinephrine
Standard carePlacebo comparatorParticipants allocated to the control arm will receive standard care as defined by the UK NICE guidelines and the Surviving Sepsis Campaign guidelines during the 48 hour study period post randomisation. All other care will be as per local protocol.
Receives: Other: Balanced Crystalloid

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The primary objective is to determine whether early PVI (within 12 hours of admission) targeted to MAP of ≥65 mmHg improves clinical effectiveness in hospitalised adult patients with septic shock compared with usual care, in the first 48 hours.

    The primary objective is measured by the Primary outcome of 'Days Alive and Out of Hospital at 90 Days'.

    Measured: 90 days post randomisation

Secondary outcomes (17)
  1. Accumulated Total Volume of IV fluid

    Accumulated volume of IV fluid delivered in each arm - excluding fluid volumes less than 100ml

    Measured: 6,12, 24, 48 and 72 hours post randomisation

  2. Lactate clearance from baseline

    Blood lactate value - arterial or venous

    Measured: 6, 12, 24, 48 & 72 hours post randomisation

  3. Total Dose of Norepinephrine

    Total dose of norepinephrine delivered by any route (peripheral or central) at each timepoint

    Measured: 6, 12, 24, 48 and 72 hours post randomisation

  4. Proportion of patients who receive vasopressors

    Proportion of patients recruited to control arm who receive any vasopressor (norepinephrine, vasopressin, metarminol, epinephrine) at each time point

    Measured: 6, 12, 24 and 48 hours after recruitment to the control arm

  5. Proportion of patients who require central venous access

    Decision to treat based on treating clinician judgement

    Measured: 24 and 48 hours post randomisation

  6. Proportion of patients developing acute kidney injury

    Acute kidney injury in line with the (p) RIFLE (paediatric Risk, Injury, Failure, Loss, End stage renal disease, AKIN (Acute kidney injury network) or KDIGO (Kidney Disease: Improving Global Outcomes) definitions by using any of the following criteria

    • a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
    • a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
    • a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults

    Measured: During the first 72 hours post randomisation

  7. Proportion of patients receiving parenteral corticosteroid

    defined as new prescription of parenteral corticosteroid

    Measured: 24, 48 & 72 hours post randomisation

  8. Length of hospital stay for index admission

    index hospital admission ends when the patient is discharged from the facility providing definitive treatment for the episode of sepsis leading to inclusion in the study

    Measured: up to hospital discharge

  9. Proportion of participants needing renal replacement therapy during index hospital admission

    decision to treat based on treating clinician judgement; participants who receive new renal replacement therapy; participants with chronic renal replacement initiated prior to the index admission will not be eligible to meet this endpoint

    Measured: index admission

  10. Proportion of participants needing non-invasive ventilation during index hospital admission

    decision to treat based on treating clinician judgement; defined as admissions receiving mask/hood CPAP or mask/hood BiPAP or non-invasive ventilation; admissions receiving CPAP via a tracheostomy

    Measured: index admission

  11. Proportion of participants needing advanced respiratory support (ICNARC definition)

    decision to treat based on treating clinician judgement; Patients who receive one or more of the following: A. Patients who receive invasive mechanical ventilation via endotracheal or tracheostomy tube, except those intubated solely for a procedure and extubated within 24 hours B. BiPAP (bilevel positive airway pressure) applied via a trans-laryngeal tracheal tube or applied via a tracheostomy C. CPAP (continuous positive airway pressure) via a translaryngeal tune of applied via a tracheostomy D. extracorporeal respiratory support

    Measured: index admission

  12. Total dose of other vasopressor

    Total dose of other vasopressors delivered by any route (peripheral or central) at each timepoint

    Measured: 6, 12, 24, 48, 72 hours post randomisation

  13. All-cause mortality during index hospital admission and at 30 and 90 days

    All-cause mortality during index hospital admission and at 30 \& 90 days post randomisation

    Measured: index admission and at 30 & 90 days post randomisation

  14. Readmission, post initial hospital discharge, in first 30 days and 90 days post randomisation

    Re-admission to an acute healthcare facility in the first 30 \& 90 days post randomisation, following a discharge from the index hospital admission to the participants care setting in the community. This includes planned and unplanned admissions. For both readmission outcomes, an acute care facility is any acute care hospital, emergency department admission >24 hours, critical care area or short stay admission or observation area.

    Measured: 30 & 90 days post randomisation

  15. Proportion of participants admitted to and length of stay in critical care (level 2 or 3) during index hospital admission

    Proportion of participants admitted to and length of stay in critical care (level 2 or 3) during index hospital admission

    Measured: During Index Hospital Admission

  16. Discharge Diagnosis

    Main diagnosis for index hospital admission, and all subsequent re-admissions

    Measured: At initial Index Hospital Discharge & at any subsequent hospital discharges following any re-admissions (post Initial Index Hospital Discharge) 90 days post randomisation.

  17. HRQoL

    Derived from EQ-5D-5L index values

    Measured: Baseline, 30 & 90 Days Post randomisation

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Jan 2022
  2. Study start11 Oct 2022
  3. Primary completionNov 2026 (estimated)
  4. Study completionOct 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Open label, two arm, multicentre, pragmatic parallel group randomised trial with an internal pilot
Masking
None (open label)
Enrolment
1,006 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05179499
Sponsor's protocol ID
GN20AE342
Other IDs
2021-006886-39
Acronym
EVIS
Status last verified
Feb 2026
First submitted
11 Nov 2021
Last updated
12 Feb 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: to be confirmed

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Norepinephrine and Balanced Crystalloid in people with Sepsis, run by NHS Greater Glasgow and Clyde at 25 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 12 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 25 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Hannah Greenwood (0141 314 4366, Hannah.Greenwood@nhs.scot), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The primary objective is to determine whether early PVI (within 12 hours of admission) targeted to MAP of ≥65 mmHg improves clinical effectiveness in hospitalised adult patients with septic shock compared with usual care, in the first 48 hours. (time frame: 90 days post randomisation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Feb 2026.

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