The ANDROMEDA-SHOCK-2 trial provided high-quality evidence for personalized hemodynamic resuscitation guided by capillary refill time (CRT) in early septic shock. This multicenter trial across 19 countries demonstrated that CRT-guided personalized hemodynamic resuscitation was superior to usual care for a hierarchical composite outcome of mortality, duration of vital support, and hospital length of stay [1]. Among 1,467 patients, the intervention achieved a win ratio of 1.16, primarily driven by reduced duration of vital organ support rather than mortality reduction alone [1].
Why it matters:
- For clinicians: CRT-guided resuscitation provides a simple, non-invasive bedside assessment tool to personalize fluid, vasopressor, and inotrope management in septic shock. This approach moves beyond one-size-fits-all protocols toward individualized hemodynamic targets based on peripheral perfusion.
- For researchers: The hierarchical composite endpoint methodology captures multiple dimensions of patient-centered outcomes beyond mortality alone, offering a more nuanced assessment of resuscitation strategies. Further work is needed to understand which patient subgroups benefit most from CRT-guided therapy.
References
- Hernández G, Ospina-Tascón GA, Damiani LP, et al. Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial. JAMA. 2025;334(22):1988-1999. doi: 10.1001/jama.2025.20402 PubMed: https://pubmed.ncbi.nlm.nih.gov/41159835/