A 1-Hour Resuscitation Bundle for Prehospital Management of Septic Shock
14 affiliations
- 1Intensive Care Unit, Service d’Aide Médicale Urgente (SAMU) de Paris, Necker – Enfants Malades Hospital, GHU Paris Centre, Assistance Publique – Hôpitaux de Paris, Paris Cité University, Paris, France.
- 2Institut de Recherche bioMédicale et d’Epidémiologie du Sport, EA7329, INSEP, Paris University, Paris, France.
- 3Centre de recherche en Epidémiologie et Santé des Populations, U1018 INSERM, Paris Saclay University, Paris, France.
- 4LIRSO, Université d’Orléans, Orléans, France.
- 5Paris Fire Brigade, Paris, France.
- 6Department of Intensive Care, Raymond Poincaré Hospital, Assistance Publique – Hôpitaux de Paris, Versailles Saint Quentin University – Paris Saclay University, Paris, France.
- 7IHU SEPSIS (PROMETHEUS Comprehensive Sepsis centre), Garches, France.
- 8Laboratory of Infection and Inflammation – U1173, School of Medicine Simone Veil, Versailles Saint Quentin University – Paris Saclay University, INSERM, Garches, France.
- 9FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), Garches, France.
- 10Inserm, Pharmacologie et évaluations des thérapeutiques chez l’enfant et la femme enceinte, Paris Cité University, Paris, France.
- 11Unité de Recherche clinique/Centre d’Investigation Clinique Necker P1419 Necker Cochin, GHU Paris Centre, Assistance Publique – Hôpitaux de Paris, Paris, France.
- 12Intensive Care Unit, Cochin Hospital, GHU Paris Centre, Assistance Publique – Hôpitaux de Paris, Paris Cité University, Paris, France.
- 13Service d’Aide Médicale Urgente (SAMU) 972, University Hospital of Martinique, Fort-de-France, Martinique, University of the Antilles, Martinique, France.
- 14UR5_3 PC2E Pathologie Cardiaque, Toxicité Environnementale et Envenimations, Martinique, University of the Antilles, Martinique, France.
Abstract
OBJECTIVES: To investigate the effect of a 1-hour resuscitation bundle, including early antibiotics, hemodynamic optimization with fluids and vasopressors as needed, and hydrocortisone therapy as needed, implemented in a prehospital setting by a mobile ICU (MICU) team, on 28-day mortality in adults with septic shock. DESIGN: A multicenter, open-label, cluster-randomized study from May 09, 2016, to November 2, 2018. SETTINGS: Prehospital emergency ambulance in France. PATIENTS: Adults with suspected septic shock at the time of management by the prehospital MICU team. INTERVENTIONS: The 1-hour resuscitation bundle included antibiotics, up to 35 mL/kg of ideal body weight of isotonic saline administered within the first 60 minutes, norepinephrine if mean blood pressure (MBP) remained less than 65 mm Hg or if diastolic blood pressure remained less than 40 mm Hg, and 100 mg of IV hydrocortisone when MBP remained less than 65 mm Hg while the patient was receiving greater than or equal to 1.5 mg/hr of norepinephrine. MEASUREMENTS AND MAIN RESULTS: The primary outcome was 28-day all-cause mortality. Secondary outcomes included mortality rates in the ICU, at hospital discharge, and at 90 days, time alive free of vasopressor drugs, invasive mechanical ventilation, renal replacement therapy, and ICU and hospital lengths of stay. Of 398 participants, 17 did not consent; therefore, 381 participants (96%; mean age, 67 ± 15 yr) were analyzed. In total, 23 of 103 deaths (22%) occurred by 28 days in the 1-hour bundle arm and 76 of 278 deaths (27%) in the usual care arm (risk ratio, 0.81; 95% CI [0.61-1.08]; p = 0.16). The intracluster correlation coefficient was estimated at 0.005 ± 0.002. Secondary outcomes were similar between groups. CONCLUSIONS: The prehospital initiation of a 1-hour resuscitation bundle did not reduce 28-day all-cause mortality in adults with septic shock. Imbalances in patient enrollment between centers and a small difference in care provided between the groups may explain these results. TRIAL REGISTRATION NUMBER: NCT02473263 (http://clinicaltrials.gov/).
Related
- Early Vasopressor Initiation Before Complete Fluid Resuscitation in Adults With Septic Shock: A Systematic Review
- Effect of capillary refill time-guided resuscitation on early fluid administration and fluid balance in septic shock: a single-center randomized controlled trial
- Hyponatremia in septic shock: Pathophysiology, fluid resuscitation challenges, and neurological complications
- Balanced Crystalloids Versus Normal Saline for Fluid Resuscitation in Pediatric Septic Shock: An Updated Systematic Review and Meta-Analysis
- Dynamics of ventriculo-arterial coupling and peripheral tissue perfusion during early resuscitation of septic shock.
BibTeX
@article{jouffroy20261hour,
title = {{A 1-Hour Resuscitation Bundle for Prehospital Management of Septic Shock}},
author = {Romain Jouffroy and Djillali Annane and Caroline Elie and Jean Paul Mira and Léa Jilet and Papa Gueye and Benoît Vivien},
journal = {Critical Care Medicine},
year = {2026},
month = aug,
doi = {10.1097/ccm.0000000000007283},
url = {https://hal.science/hal-05749301v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - A 1-Hour Resuscitation Bundle for Prehospital Management of Septic Shock
AU - Romain Jouffroy
AU - Djillali Annane
AU - Caroline Elie
AU - Jean Paul Mira
AU - Léa Jilet
AU - Papa Gueye
AU - Benoît Vivien
PY - 2026
DA - 2026/08/10
JO - Critical Care Medicine
DO - 10.1097/ccm.0000000000007283
UR - https://hal.science/hal-05749301v1
AB - OBJECTIVES: To investigate the effect of a 1-hour resuscitation bundle, including early antibiotics, hemodynamic optimization with fluids and vasopressors as needed, and hydrocortisone therapy as needed, implemented in a prehospital setting by a mobile ICU (MICU) team, on 28-day mortality in adults with septic shock. DESIGN: A multicenter, open-label, cluster-randomized study from May 09, 2016, to November 2, 2018. SETTINGS: Prehospital emergency ambulance in France. PATIENTS: Adults with suspected septic shock at the time of management by the prehospital MICU team. INTERVENTIONS: The 1-hour resuscitation bundle included antibiotics, up to 35 mL/kg of ideal body weight of isotonic saline administered within the first 60 minutes, norepinephrine if mean blood pressure (MBP) remained less than 65 mm Hg or if diastolic blood pressure remained less than 40 mm Hg, and 100 mg of IV hydrocortisone when MBP remained less than 65 mm Hg while the patient was receiving greater than or equal to 1.5 mg/hr of norepinephrine. MEASUREMENTS AND MAIN RESULTS: The primary outcome was 28-day all-cause mortality. Secondary outcomes included mortality rates in the ICU, at hospital discharge, and at 90 days, time alive free of vasopressor drugs, invasive mechanical ventilation, renal replacement therapy, and ICU and hospital lengths of stay. Of 398 participants, 17 did not consent; therefore, 381 participants (96%; mean age, 67 ± 15 yr) were analyzed. In total, 23 of 103 deaths (22%) occurred by 28 days in the 1-hour bundle arm and 76 of 278 deaths (27%) in the usual care arm (risk ratio, 0.81; 95% CI [0.61-1.08]; p = 0.16). The intracluster correlation coefficient was estimated at 0.005 ± 0.002. Secondary outcomes were similar between groups. CONCLUSIONS: The prehospital initiation of a 1-hour resuscitation bundle did not reduce 28-day all-cause mortality in adults with septic shock. Imbalances in patient enrollment between centers and a small difference in care provided between the groups may explain these results. TRIAL REGISTRATION NUMBER: NCT02473263 (http://clinicaltrials.gov/).
SN - 0090-3493
SN - 1530-0293
ER -