SGEM#498: Andromeda – Cap Refill Time for Personalized Sepsis Treatment

Personalized hemodynamic resuscitation targeting capillary refill time in septic shock patients shows no significant mortality benefit compared to usual care, according to the Andromeda Shock 2 trial. While the study reports a statistically significant advantage in a hierarchical composite outcome, this result is primarily driven by a reduction in the duration of vital support—specifically renal replacement therapy—rather than life-saving outcomes. The trial, an open-label randomized control study featuring emergency physician and First 10 EM creator Dr. Justin Morgenstern, highlights the limitations of using composite endpoints and the potential for performance bias in intensive care settings. Clinicians should remain cautious, as the protocol requires significant resources and lacks evidence of improved survival. Attentive patient monitoring remains essential for managing septic shock, but the specific six-hour algorithm tested does not currently warrant routine clinical adoption.