Historical collection · First published Oct 29, 2025; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesPersonalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial
Summary
In 1,467 analyzed patients with early septic shock, a personalized protocol targeting capillary refill normalization improved a hierarchical composite of death, duration of vital support, and hospital stay versus usual care. The difference was driven mainly by shorter vital support, rather than demonstrated mortality reduction.
Why it matters
Serial capillary refill can support a structured resuscitation assessment alongside fluid responsiveness and bedside echocardiography. The intervention was a treatment algorithm, not an isolated capillary-refill target.
Study at a glance
- Design
- Randomized trial
- Population
- Adults within four hours of septic shock in 86 centers across 19 countries.
- Sample size
- 1467
- Intervention
- Personalized hemodynamic protocol using capillary refill, pulse/diastolic pressure, fluid responsiveness and echocardiography.
- Comparator
- Usual care.
- Primary endpoint
- Hierarchical day-28 composite: mortality, duration of vital support, then hospital stay.
Main findings
- Primary composite win ratio 1.16 (95% CI 1.02-1.33).
- 1,501 randomized; 1,467 included in the primary analysis.
Limitations
Unblinded care and a hierarchical composite complicate attribution of benefit. Patients were managed in 86 ICUs, limiting direct extrapolation to all ED sepsis presentations.
Read the primary source
Full text: Open-access full text available.
Original sourcePMID: 41159835
Material reviewed: abstract.
Source retrieved Oct 27, 2026. Publisher abstract and selected indexed methods/conclusion passages reviewed; complete full text was not reviewed. Legal PMC12573117 manuscript identified. Publisher first-online date October 29 precedes December 9 print date.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.