The Frame of Survival for Sepsis: A Practical Systems Framework for Time-Sensitive Critical Illness in Low-Resource Settings.

Abstract

Objectives: Sepsis is a time-sensitive cause of preventable death worldwide, with disproportionate mortality in low-resource settings (LRS). Many recommendations in international sepsis guidance presume resources unavailable in many facilities and communities. We sought to develop a practical framework that helps health systems embed feasible sepsis actions within broader emergency and essential critical care systems, while highlighting where evidence is limited and where local learning systems are needed.

Data sources: A targeted scoping review of peer-reviewed and grey literature on sepsis epidemiology, emergency care systems, essential emergency and critical care, implementation strategies, and quality improvement (QI) in LRS; and key guideline and policy documents relevant to sepsis and emergency care.

Study selection: We prioritized publications and guidance relevant to LRS, including observational studies, pragmatic implementation reports, consensus statements, and policies addressing emergency care organization, workforce, supply chains, diagnostics, and QI.

Data extraction: Task force members abstracted actionable strategies, implementation barriers/enablers, and feasibility considerations across the care continuum (community, transport/prehospital, facility-based acute care, and referral). We also identified domains where guideline certainty is low or indirect for LRS.

Data synthesis: A Society of Critical Care Medicine-convened multidisciplinary task force iteratively developed the "Sepsis Frame of Survival" using a structured process that included 1) scoping evidence review, 2) a Delphi-style prioritization of candidate framework elements by importance and feasibility, and 3) a structured consensus meeting ("Utstein-style" conference format) to finalize the model and its priority actions. We produced a concise implementation roadmap and a feasible measurement set aligned with resource constraints.

Conclusions: The Sepsis Frame of Survival is a pragmatic model to organize sepsis improvement as part of emergency and essential critical care strengthening. It emphasizes high-impact actions that can be implemented with limited resources (triage and early recognition, timely antimicrobials, oxygen and basic supportive care, cautious fluid resuscitation with reassessment, source control and referral, diagnostics/microbiology where feasible, and QI). The framework explicitly distinguishes near-term, feasible changes from longer-term system investments and highlights the need for locally generated evidence to guide quality indicators and resuscitation strategies in LRS.