A straightforward, bedside-centered method for managing septic shock in its early stages is personalized hemodynamic resuscitation based on capillary refill time. This approach seeks to lessen fluid overload, increase tissue oxygenation, and perhaps improve results during the crucial early hours of treatment by concentrating on microcirculatory perfusion rather than just global metrics. Thus, this study looked in to the impact of a customized hemodynamic resuscitation procedure that targets capillary refill time (CRT-PHR) on a hierarchical composite outcome comprising length of hospital stay, duration of vital support, and fatality.
86 locations across 19 nations participated in this randomized clinical study. Between March 2022 and April 2025, patients who experienced septic shock during the first 4 hours were included; the last follow-up was in July 2025. In order to customize fluids, vasopressors, and inotropes, patients were randomly assigned to either standard treatment (n = 747) or CRT-PHR (n = 720), which included assessments of pulse pressure, diastolic arterial pressure, fluid responsiveness, and bedside echocardiography.
A hierarchical composite of death, length of hospital stay measured at 28 days, and duration of vital support (vasoactives, mechanical breathing, and renal replacement treatment) was the main outcome. Starting with the initial event in the hierarchy and stratified by median APACHE (Acute Physiology and Chronic Health Evaluation) II score upon admission, a win ratio for the primary outcome was computed by comparing all potential patient pairings. Mortality, vital support-free days, and hospital stay duration at 28 days were secondary outcomes.
The primary analysis comprised 1467 of the 1501 randomized patients (mean age, 66 [17] years; 43.3% female). For the hierarchical composite primary outcome, the CRT-PHR group had 131 131 victories (48.9%) compared to 112 787 (42.1%) in the usual treatment group; the win ratio was 1.16 (95% CI, 1.02-1.33; P =.04). The intervention group outperformed the standard care group in terms of individual victories for mortality (19.1% vs. 17.8%), length of hospital stay (3.4% vs. 3.2%), and duration of critical support (26.4% vs. 21.1%).
Overall, a customized hemodynamic resuscitation technique that focused on capillary refill time was better than standard treatment for the key composite outcome in patients with early septic shock, mainly because it required less critical support.
Source:
ANDROMEDA-SHOCK-2 Investigators for the ANDROMEDA Research Network, Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), and Latin American Intensive Care Network (LIVEN), Hernandez, G., Ospina-Tascón, G. A., Kattan, E., Ibarra-Estrada, M., Ramasco, F., Orozco, N., Ramos, K., Aldana, J. L., Ferri, G., Hamzaoui, O., De Backer, D., Teboul, J.-L., Vieillard-Baron, A., Petri Damiani, L., García-Gallardo, G. A., Morales, S., Carmona Garcia, P., Mendez, R., … Biasi Cavalcanti, A. (2025). Personalized hemodynamic resuscitation targeting capillary refill time in early septic shock: The ANDROMEDA-SHOCK-2 randomized clinical trial: The ANDROMEDA-SHOCK-2 randomized clinical trial. JAMA: The Journal of the American Medical Association, 334(22), 1988–1999. https://doi.org/10.1001/jama.2025.20402
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