- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03584295
Early Extubation by ECCO2R Compared to IMV in Patients With Severe Acute Exacerbation of COPD (X-COPD)
A Multicentre, Randomized-controlled Trial of EXtracorporeal CO2 Removal to Facilitate Early Extubation Compared to Invasive Mechanical Ventilation in Patients With Severe Acute Exacerbation of COPD (X-COPD)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The current study hypothesizes an advantage for veno-venous extracorporeal carbon dioxide removal (VV-ECCO2R) in severe acute exacerbation of COPD requiring invasive mechanical ventilation (IMV) to facilitate early extubation in terms of reducing mortality or severe disability. The study hypothesizes that avoiding IMV could reduce mortality and substantially improve quality of life, especially in regard to avoidance of tracheostomy and long-term home IMV. Improvement in mobility due to sooner recovery has a further major impact on patients' QoL.
After randomization patients with acute exacerbation of severe COPD, requiring invasive mechanical ventilation will be treated either with conventional care or VV-ECCO2R to facilitate early extubation. VV-ECCO2R is used in a standard configuration with either double lumen cannula (22-24Fr) or two small single vessel cannulas (15-19 Fr), allowing a blood flow rate between 1-1.75 L/min.
Conventional care in the control arm includes invasive mechanical ventilation and the attempt to extubate the patient as early as possible and to switch to non-invasive ventilation (NIV). If extubation fails, tracheostomy can be performed according to the discretion of the treating physician.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Celina Erfle
- Phone Number: +49617260993208
- Email: celina.erfle@fmc-ag.com
Study Locations
-
-
-
Köln, Germany, 51109
- Recruiting
- Kliniken der Stadt Köln gGmbH, ARDS and ECMO Zentrum Köln-Merheim
-
Contact:
- Christian Karagiannidis, Prof. Dr.
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Informed consent signed and dated by the investigator; and
- if patient is able to give consent: by the study patient
- if patients unable to give consent: by the legal representative or
- if an emergency situation is determined: by an independent consultant physician.
- Minimum age of 18 years
In case of female patients:
- Postmenopausal status defined as I. Prior bilateral oophorectomy Or II. Age ≥60 years Or if Age is <60 years or cannot be determined
- A negative pregnancy test, defined as negative beta hCG test with a hCG level <5 mIU/mL.
- Known History of COPD
- Acute exacerbation of COPD requiring invasive mechanical ventilation
- Failed extubation attempt or extubation not possible within 24 hours after intubation
- Acute and potentially reversible cause of respiratory failure as determined by the treating physician
Exclusion Criteria:
- Any conditions which could interfere with the patient's ability to comply with the study
- In case of female patients: pregnancy and lactation period
- Participation in any interventional clinical study during the preceding 30 days
- Platelets <70.000/µl at baseline
- Previous participation in the X-COPD study
- Endotracheally intubated and mechanically ventilated for >96 hours prior to randomization
- Acute liver failure, defined by an international normalized ratio (INR) >2 without anticoagulation and/or bilirubin >4 mg/dL (>68 μmol/L) and/or hepatic encephalopathy (all three apply)
- PaO2/FiO2 ratio <120 mmHg measured with FiO2 of 1.0
- Expectation of disease progression leading to high-flow extracorporeal membrane oxygenation (ECMO) treatment
- Cerebral haemorrhage
- Tracheostomy
- Estimated life expectancy <6 months due to reasons other than COPD
- Acute ischemic stroke
- Contraindication to anticoagulation
- Severe chronic liver disease (Child Pugh C)
- Acute pulmonary embolism requiring thrombolytic therapy
- Acute or chronic heart failure with left ventricular ejection fraction <30%
- Acute or chronic renal failure requiring dialysis
- Organ transplantation or immunosuppression due to ongoing immunosuppressive medication or neutropenia for instance following organ transplantation or anticancer therapy
- Neuromuscular disorder or chronic restrictive lung disease affecting native lung ventilation
- Known Heparin induced thrombocytopenia type II
- Acute coronary syndrome and myocardial infarction
- Obesity hypoventilation syndrome
- BMI >40
- Patient not expected to survive 48 hours
- Do not resuscitate (DNR) order
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 |
---|---|
Active Comparator: Conventional care
Patients with acute exacerbation of severe COPD, requiring invasive mechanical ventilation treated with Conventional care.
Conventional care includes invasive mechanical ventilation and the attempt to extubate the patient and switch to NIV.
If extubation fails tracheostomy can be performed according to the treating physician.
|
Patient with acute exacerbation of severe COPD, requiring invasive mechanical ventilation treated with Conventional Care.
Conventional care includes invasive mechanical ventilation and the attempt to extubate the patient and switch to NIV.
If extubation fails tracheostomy can be performed according to the treating physician.
|
Experimental: Extracorporeal carbon dioxide removal
Patients with acute exacerbation of severe COPD, requiring invasive mechanical ventilation will be treated with vv-ECCO2R (Extracorporeal carbon dioxide removal) to facilitate early extubation.
ECCO2R is used in a standard configuration with either double lumen cannula (22-24Fr) or two small single vessel cannulas (15-19 Fr), allowing a blood flow rate between 1-1.75 L/min.
|
Patients with acute exacerbation of severe COPD, requiring invasive mechanical ventilation will be treated with vv-ECCO2R to facilitate early extubation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Death or severe disability
Time Frame: day 60
|
Death or severe disability at day 60 after randomization, with severe disability defined as confinement to bed and/or inability to wash or dress alone and/or need for long-term invasive mechanical ventilation by day 60
|
day 60
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mortality or severe disability at day 180 after randomization
Time Frame: Day 180
|
Change in mortality/severe disability rate
|
Day 180
|
Ventilator-associated pneumonia during ICU treatment
Time Frame: up to 60 days
|
|
up to 60 days
|
Reintubation rate
Time Frame: until day 180 after randomization
|
Number of reintubations
|
until day 180 after randomization
|
Days on IMV or noninvasive ventilation (NIV) or ECCO2R
Time Frame: up to 60 days
|
defined as duration of total ventilatory support
|
up to 60 days
|
Thrombosis during treatment period
Time Frame: up to 29 Days
|
Thrombosis of major venous vessels during the treatment period
|
up to 29 Days
|
Quality of life of patient
Time Frame: up to 180 days
|
Measured at day 60 and 180 after randomization, measured with Severe Respiratory Insufficiency and EQ-5D-5L Questionnaire
|
up to 180 days
|
Renal function
Time Frame: up to 29 days
|
Worsening of renal function
|
up to 29 days
|
Mobility, measured with ActiGraph
Time Frame: up to 180 days
|
Subgroup: Activity measurement with ActiGraph (at 1 centre)
|
up to 180 days
|
Treatment Cost
Time Frame: up to 180 days
|
Total Treatment costs for the hospital stay
|
up to 180 days
|
Length of hospital stay
Time Frame: Up to 180 Days
|
Change in days of hospital stay
|
Up to 180 Days
|
Need of tracheostomy
Time Frame: Up to 180 Days
|
Change in rate of tracheostomy
|
Up to 180 Days
|
Breathing
Time Frame: up to 60 days
|
Breathing through tracheostomy at day 60 after randomization
|
up to 60 days
|
Readmission
Time Frame: Up to 180 Days
|
Readmission to hospital within 180 days after randomization
|
Up to 180 Days
|
Exacerbations
Time Frame: Up to 180 Days
|
Number of exacerbations within 180 days after randomization
|
Up to 180 Days
|
Severe Bleeding
Time Frame: up to 60 days
|
Defined as any bleeding event requiring administration of 1 unit of packed red cells, Detection of severe bleeding
|
up to 60 days
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Christian Karagiannidis, Prof. Dr., Kliniken der Stadt Köln gGmbH, ARDS and ECMO Zentrum Köln-Merheim
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- COPD-ECCO2R-01-INT
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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