RCT

ANDROMEDA-SHOCK

Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Level on 28-Day Mortality

JAMA, 2019 · Multicenter randomized trial (n=424)

Clinical question

Does capillary refill time (CRT)-guided resuscitation improve outcomes compared with lactate-guided resuscitation in septic shock?

Population: Adults with early septic shock within 4 hours of diagnosis
Intervention: Resuscitation protocol targeting CRT normalization (<= 3 seconds)
Comparator: Resuscitation protocol targeting lactate clearance (>= 20% every 2 hours)
Primary outcome: 28-day all-cause mortality
Result: 28-day mortality was 34.9% in the CRT group vs 43.4% in the lactate group (hazard ratio 0.75; 95% CI 0.55–1.02; P=0.06) and the CRT group had a modestly lower SOFA score at 72 hours.

What the trial found

CRT-guided resuscitation did not significantly reduce the primary 28-day mortality endpoint but was associated with modestly less organ dysfunction at 72 hours.

Current guideline position

Current sepsis/shock guidance supports CRT as an adjunct to other perfusion measures rather than as a stand-alone replacement for lactate.

Clinical interpretation

Supports CRT as a rapid bedside perfusion marker within a multimodal resuscitation strategy; it should not be presented as proven mortality-superior to lactate-guided care.

Clinical Context & Relevant Topics (2)

Disease Reference

Shock: Foundational Critical Care Framework

Cellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.

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Septic Shock

The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.

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