Sepsis & septic shock · What to resuscitate towards
Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock
| Design | Multicentre randomised clinical trial with a hierarchical composite endpoint |
|---|---|
| Treatment | Personalised haemodynamic resuscitation targeting capillary refill time |
| Control | Usual care |
| Population | 1467 patients analysed with early septic shock, mean age 66, 43.3% female |
| Follow-up | 28 days |
| Primary endpoint | Hierarchical composite analysed by win ratio |
| Result | There were 131,131 wins (48.9%) in the capillary refill time group versus 112,787 (42.1%) in the usual care group for the hierarchical composite. |
| Secondary endpoints | Mortality, organ dysfunction, resuscitation intensity |
Among patients with early septic shock, a personalized hemodynamic resuscitation protocol targeting capillary refill time was superior to usual care for the primary composite outcome, primarily due to a lower duration of vital support.
The trial authors, in the published abstract
After two decades of failed protocols (Rivers EGDT and its three replications), a target that requires nothing more than a finger and a stopwatch outperforms usual care. Win-ratio composites are hard to interpret clinically, so the practical size of the benefit is less clear than its direction.
Hernandez G, Ospina-Tascón GA, Kattan E, et al. Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial. JAMA 2025 Dec 9;334(22):1988-1999.