90. Rapid Fire Journal Club: ANDROMEDA-SHOCK

Nov 27, 2024

Jose Meade Aguilar, an Internal Medicine resident at Boston University, dives into the ANDROMEDA-SHOCK trial. He compares capillary refill time (CRT) to lactate-guided resuscitation in septic shock, highlighting CRT's advantages as a rapid assessment tool. The trial's aim and multicenter design are outlined, with a focus on the patient demographics and measuring techniques used. While the results showed an 8.5% mortality difference favoring CRT, it wasn't statistically significant. Jose also emphasizes the practical use of CRT in clinical settings.

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INSIGHT

CRT Is A Fast, Practical Perfusion Marker

Capillary refill time (CRT) is a rapid, low-cost measure that reflects peripheral perfusion and responds quickly to resuscitation changes.
Lactate can be elevated for nonhemodynamic reasons and may clear slower, limiting its bedside responsiveness.

INSIGHT

Trial Compared CRT vs Lactate For Mortality

ANDROMEDA-SHOCK tested whether CRT-guided resuscitation reduced 28-day mortality compared with lactate-guided care.
The trial used meaningful clinical outcomes including 90-day mortality and organ support-free days.

ADVICE

Enroll Early, Exclude Major Confounders

Include adult patients with septic shock after initial fluids and exclude major confounders like severe ARDS, active bleeding, and DNR status.
Enroll early (within 4 hours of meeting shock criteria) to focus on early resuscitation effects.

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