S01E11 ANDROMEDA-SHOCK 2, the Return of Capillary Refill

In this episode of PRISM Rounds, we journal-club ANDROMEDA-SHOCK 2, a multinational randomized clinical trial testing whether a personalized hemodynamic resuscitation protocol targeting capillary refill time (CRT-PHR) improves outcomes in early septic shock compared with usual care. The primary outcome was a 28-day hierarchical composite of mortality, duration of vital support, and hospital length of stay, analyzed using a win ratio approach. We walk through the protocol logic, feasibility at the bedside, and what drove the primary result (including whether effects clustered in mortality vs vital-support duration), then close with practical takeaways for ICU/ED teams. Educational use only — not medical advice. Source (JAMA/DOI): https://doi.org/10.1001/jama.2025.20402. Trial registration: https://clinicaltrials.gov/study/NCT05057611.Tags: Septic shock; Sepsis; Critical care; ICU; Emergency medicine; Hemodynamic resuscitation; Capillary refill time; CRT; Vasopressors; Norepinephrine; Lactate; Fluid resuscitation; Bedside ultrasound; Echocardiography; Clinical trial; Randomized trial; JAMA; Journal club; Evidence-based medicine; PRISM Rounds