ANDROMEDA-SHOCK
Trial question
Is peripheral perfusion-guided resuscitation superior to lactate-guided resuscitation in patients with septic shock?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
53.0% female
47.0% male
N = 424
424 patients (226 female, 198 male)
Inclusion criteria: patients with septic shock
Key exclusion criteria: bleeding, severe ARDS, do-not-resuscitate status, pregnancy
Interventions
N=212 peripheral perfusion-guided resuscitation
N=212 lactate-guided resuscitation
Primary outcome
Death at 28 days
34.9
43.4
43.4 %
32.5 %
21.7 %
10.8 %
0.0 %
Peripheral perfusion-guided resuscitation
Lactate-guided resuscitation
No significant difference ↔
No significant difference in death at 28 days (34.9% vs. 43.4%; HR 0.75, 95% CI 0.55 to 1.02)
Secondary outcomes
Significant decrease in SOFA score at 72 hours (5.6 vs. 6.6 ; MD -1, 95% CI -1.97 to -0.02)
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In patients with septic shock, peripheral perfusion-guided resuscitation was not superior to lactate-guided resuscitation with respect to death at 28 days.
Reference
Hernandez G, Ospina-Tascon GA, Damiani LP et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019 Feb 19;321(7):654-664.
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