- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00159926
Cleansing of Suction Blood in Cardiac Surgery for Reduced Inflammatory Response
Does Cleansing of Suction Blood During Cardiac Surgery With Heart and Lung Machine Reduce the Postoperative Inflammatory Response ?
Study Overview
Status
Intervention / Treatment
Detailed Description
Introduction
Cardiopulmonary bypass (CPB) during cardiac surgery induces in all patients a systemic inflammatory response syndrome (SIRS) that is more pronounced than for other surgical procedures. Depending on the severity of this, myocardial dysfunction, respiratory failure, renal and neurological dysfunction, coagulation disturbances and impaired liver function might follow. In worst cases this leads to acute respiratory distress syndrome, disseminated intravascular coagulation, multi organ failure, shock and death. The cause is besides the surgical trauma, the passage of the blood through the extra corporal circulation (ECC) and its pumps and oxygenator, hemodilution, hypothermia, heparin and protamine administration, ischemia and reperfusion, and endotoxemia (LPS) as a cause of intestinal ischemia. The ECC is the main cause of immunological activation and leads in severe cases to the so-called post-perfusion syndrome. This is characterised by increased capillary permeability and intercellular fluid, peripheral vasoconstriction, fever, myocardial edema, diffuse cerebral edema and diffuse hemorrhagic diathesis. This syndrome is considered to be a more severe form of SIRS. Even though most patients have no sequelae after CPB, all patients must be considered to be influenced, in varying degree, by SIRS. High levels of pro-inflammatory cytokines (interleukin (IL)-6, IL-8, IL-1a, IL-1b, tumor necrosis factor (TNF) alfa), have generally been associated with adverse events after CPB. Of importance is also LPS from gram-negative intestinal bacteria, translocating to the systemic circulation during ischemia.
Hypothesis
Cleansing of suction blood and the remaining blood in the ECC after termination of CPB, reduces the load of inflammatory cells and mediators in the patients' circulation. This potentially diminishes SIRS with a reduction in postoperative organ dysfunction and morbidity.
Aim
To cleanse suction blood and the remaining blood in the ECC after termination of CPB by means of a cell saver and monitor the influence on inflammatory mediators and the potential clinical benefits.
Outcome measures
Primary: Concentrations of IL-1B, IL-6, IL-8, IL-10, IL-12p70, TNFa, TNF-R1, TNF-R2, PCT and LPS in patient blood: 6, 24 and 72 hours after termination of CPB.
Secondary: Bleeding, need for allogenic blood transfusions and blood products and clinical effect focusing on known complications to cardiac surgery and CPB.
Design
Prospective randomised clinical trial including 40 patients planned for on-pump coronary artery bypass grafting (CABG). n=20 in the trial group (use of cell saver) and n=20 in the control group (no cell saver). No patients receive postoperative autotransfusion of drain blood.
Sample size
Estimation based on comparable studies.
Anaesthesia and surgery
In accordance with current guidelines of the clinic, this includes prophylactic antibiotics (cefuroxime and gentamycin). Cell saver: Medtronic Autolog.
Patient exclusion during the trial
Patients are excluded in cases of autotransfusion of blood not cleansed by the cell saver, for instance in cases of major blood loss.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Copenhagen, Denmark, 2100
- Department of cardiothoracic surgery, Rigshospitalet
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Oral and written informed consent.
- No limits regarding age or ejection fraction.
Exclusion Criteria:
- Off-pump coronary artery bypass grafting
- Redo CABG
- Current infection
- Antibiotic treatment
- S-creatinin > 200 micromol/L
- Antiinflammatory / immuno-modulating treatment: Steroids, immunosuppressive or -stimulating agents (NSAIDs and ASA allowed)
- Liver disease
- Immune disease
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 1
With cell saver
|
Cell saver intraoperatively for coronary artery bypass grafting using cardiopulmonary bypass
|
Active Comparator: 2
Without cell saver
|
Conventional suction for coronary artery bypass grafting using cardiopulmonary bypass
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Concentrations of IL-1B, IL-6, IL-8, IL-10, IL-12p70, TNFa, TNF-R1, TNF-R2, PCT and LPS in patient blood.
Time Frame: 6, 24 and 72 hours after termination of CPB.
|
6, 24 and 72 hours after termination of CPB.
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Bleeding
Time Frame: Intra- and postoperatively
|
Intra- and postoperatively
|
Need for allogenic blood transfusions and blood products
Time Frame: Within submission
|
Within submission
|
Clinical effect focusing on known complications to cardiac surgery and CPB
Time Frame: Within submission
|
Within submission
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Sune Damgaard, MD, Dept. of Cardiothoracic Surgery, Rigshospitalet, Copenhagen
- Study Director: Daniel A Steinbrüchel, Professor, Dept. of Cardiothoracic Surgery, Rigshospitalet, Copenhagen
Study record dates
Study Major Dates
Study Start
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 959583153
- 961501172
- DHF: 03-2-3-35-22109
- CHC: 20/fo03
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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