A 1-Hour Resuscitation Bundle for Prehospital Management of Septic Shock.
Romain Jouffroy, Djillali Annane, Caroline Elie et al.
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In 30 seconds
This multicenter, open-label, cluster-randomized study assessed whether starting a 1-hour resuscitation bundle in the prehospital setting affected 28-day mortality among adults with suspected septic shock managed by mobile ICU teams in France. The bundle included early antibiotics, fluids, vasopressors and hydrocortisone as needed. Among 381 analyzed participants, 28-day deaths occurred in 22% of the bundle group and 27% of the usual-care group (risk ratio, 0.81; 95% CI [0.61-1.08]; p = 0.16). The study concluded that prehospital bundle initiation did not reduce 28-day all-cause mortality.
Key findings
- By 28 days, deaths occurred in 22% of the bundle arm and 27% of the usual-care arm (risk ratio, 0.81; 95% CI [0.61-1.08]; p = 0.16).
- Secondary outcomes, including mortality at other time points and organ-support-free time, were similar between groups.
Why it matters
The trial evaluates whether a structured, early approach to septic shock resuscitation can be delivered before hospital arrival. Its findings do not demonstrate a significant reduction in 28-day mortality, underscoring that the potential benefit of this particular prehospital bundle remains uncertain. The results also highlight the importance of interpreting bundle effects in light of how care differed between study groups.
What to keep in mind
The authors note imbalances in enrollment between centers and only a small difference in care provided between groups, which may help explain the results.