- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00773110
Study of Albumin to Reduce Inflammation Following Surgery
Scavenging Free Haemoglobin Attenuates the Systemic Inflammatory Response Following Surgery
Study Overview
Status
Intervention / Treatment
Detailed Description
The host response to infection and other forms of tissue injury has been termed the systemic inflammatory response syndrome (SIRS). SIRS is seen in association with a wide variety of non-infective insults, including major trauma and surgical procedures, including those necessitating cardiopulmonary bypass (CPB). In this population the incidence of SIRS is high, afflicting up to 70% of patients. This may be manifest from an increased vasopressor requirement, to refractory hypotension, and multiple organ dysfunction syndrome (MODS) with liver, renal, myocardial, and neurological problems. MODS is associated with significant mortality rates of around 30-45%. Survivors require prolonged and costly intensive care, thereby representing a considerable burden for the healthcare services. Survivors often suffer considerable morbidity and have significantly impaired health related quality of life.
Despite intense investigations of anti-inflammatory therapies in SIRS and its sequelae, the case of patients is largely supportive whilst underlying triggers (such as infection) for the process are treated. Indeed, the only therapy drotrecogin alfa (activated) demonstrated to reduced mortality in a randomised study has only been investigated in patients with the most severe SIRS consequent of infection (i.e. severe sepsis) and is contra-indicated in those who have just undergone surgery.
Haemolysis is a common feature of surgery requiring CPB and may potentiate the development of SIRS and organ injury through the release of heme/iron. Furthermore, haemolysis during CPB may lead to the depletion of important mechanisms which scavenge free heme/hemoglobin from the circulation. Albumin, the most abundant plasma protein, has specific and non-specific heme and iron binding sites which are used under circumstances in which standard scavengers are overwhelmed. However, albumin is also depleted following CPB. It is therefore hypothesised that by priming the CPB circuit with albumin the heme/iron scavenging capability of the plasma will be maintained following surgery and that the systemic inflammatory response will be attenuated.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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London, United Kingdom, SW3 6NP
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Trust
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All patients over sixteen years of age undergoing surgery that requires cardiopulmonary bypass who provide informed written consent
Exclusion Criteria:
- Lack of informed consent
- Pregnancy
- Cyanotic congenital heart disease (due to high haemoglobin levels and increased haemolysis)
- Patients undergoing other extracorporeal interventions (ventricular assist devices, extracorporeal membrane oxygenators, pre-admission dialysis)
- Patients with congenital haemoglobinopathies (e.g. thalassaemia, cryoglobinuria, etc)
- Patients with disorders of iron metabolism (e.g. haemochromatosis)
- Religious objections to transfusion of a plasma-derived product
- Patients with known blood borne infection
- Patients with known hypersensitivity to gelofusine or human albumin solution
- Patients with an additive EUROSCORE of 10 or more
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: 1 Albumin
Priming of the cardiopulmonary bypass circuit with 20% human albumin solution prior to surgery
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Priming of the cardiopulmonary bypass circuit with Hartmann's solution (1000 mL), 20% Human serum albumin(300 mL), 0.9% sodium chloride solution (200 mL) and heparin (10,000 IU)
Other Names:
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PLACEBO_COMPARATOR: 2 Gelofusin
Priming of the cardiopulmonary bypass circuit with gelofusin prior to surgery
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Priming of the cardiopulmonary bypass circuit with Hartmann's solution (1000 mL), Gelofusine (300 mL, 4% succinylated gelatin, a synthetic colloid) and heparin (10,000 IU)
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Time from surgery to intensive care unit discharge
Time Frame: Hourly
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Hourly
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Degree of hemolysis - free hemoglobin and haptoglobin
Time Frame: Prior to and at 0, 2, 6 and 24 hours after CPB
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Prior to and at 0, 2, 6 and 24 hours after CPB
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Haematological and physiological markers of the inflammatory response - Temperature, pulse rate, respiratory rate, white cell count and C-reactive protein
Time Frame: At regular intervals following CPB until intensive care unit discharge
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At regular intervals following CPB until intensive care unit discharge
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Biochemical and physiological markers of organ dysfunction
Time Frame: At regular intervals following CPB until intensive care unit discharge
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At regular intervals following CPB until intensive care unit discharge
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Haematological markers of the inflammatory response
Time Frame: Prior to and at 0, 2, 6 and 24 hours after CPB
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Prior to and at 0, 2, 6 and 24 hours after CPB
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Mark J Griffiths, Royal Brompton & Harefield NHS Foundation Trust
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- CRO888
- DHTCA_P09889
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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