- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04043598
Crystalloid Fluid Choice and Neurological Outcome in Patients After Subarachnoid Haemorrhage (CRYSTALLBrain)
Crystalloid Fluid Choice and Neurological Outcome in Patients After Subarachnoid Haemorrhage - a Multi-center Randomized Double-blind Clinical Trial
Study Overview
Status
Intervention / Treatment
Detailed Description
Background: Despite ongoing advances in critical care mortality and morbidity of patients with subarachnoid hemorrhage remains high. Secondary brain injuries related to cerebral vasospasm and consecutive ischemic brain injury and intracerebral edema are the main contributors to mortality and morbidity in these patients. Evidence points towards low serum sodium levels being one of the significant risk factors for of secondary brain injury in this population. Previous studies show that fluid resuscitation with normal saline results in higher serum sodium levels and higher serum osmolality when compared to balanced infusates in patients with subarachnoid hemorrhage.
Aim: The primary objective of this study is to evaluate whether the use of a sodium-rich infusion (normal saline) results in better clinical outcome when compared to a sodium-depleted infusion (lactated Ringer's) in patients with subarachnoid hemorrhage. The primary endpoint will be the occurrence of clinically relevant vasospasm requiring immediate treatment. In addition, the investigators will assess other relevant complications such as long and short-term mortality, significant brain edema requiring conservative therapy or/and operative hemicraniectomy, as well as further patient-relevant outcomes such as days on organ support, postoperative infections, length of stay and long-term disability/mortality.
Study intervention: All patients admitted to a participating hospital with the diagnosis of intracerebral bleeding will be screened and if eligible, randomized to one of the study arms. Individual patient's consent will be sought. Thereafter, patients will receive only the allocated study fluid for fluid maintenance and resuscitation from study inclusion until ICU/intermediate care (IMC) discharge. Neurological evaluation will be performed hourly for the initial phase and thereafter two hourly. Serum sodium, osmolality, fluid, water and electrolyte balance as well as acid-base homeostasis will be evaluated daily. Further, specific assessment of renal, cardiac and immune function takes place at 5 pre-specified time-points (day 1,3,7,10 and at ICU/IMC discharge).
After ICU/IMC discharge patients will be followed for evaluation of secondary endpoints. Long-term disability will be assessed by telephone interview based on the modified the Rankin-Scale and the Glasgow Outcome Scale Extended.
Sample Size: Sample size calculation was based upon the investigators' ICU's registry data. In 2017, 44.38% patients with subarachnoid hemorrhage reached the predefined endpoint of clinically relevant vasospasm requiring immediate intervention. A clinically relevant effect size was determined to be an improvement in outcome of 15%. Based on these results a patient number of n = 160 for each group was determined under estimation of a 15% drop out rate.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Anna S Messmer, MD
- Phone Number: 0041 +41316322111
- Email: anna.messmer@insel.ch
Study Contact Backup
- Name: Research Nurses Department of Intensive Care
- Phone Number: 0041 +41316322111
- Email: kim.researchnurses@insel.ch
Study Locations
-
-
-
Bern, Switzerland, 3010
- Recruiting
- Department of Intensive Care, Bern University Hospital and University of Bern, Bern, Switzerland
-
Contact:
- Anna S Messmer, MD
- Phone Number: 0041316322111
- Email: anna.messmer@insel.ch
-
Geneva, Switzerland, 1205
- Recruiting
- Department of Intensive Care Medicine
-
Contact:
- Hervé Quintard, Prof. Dr. med.
- Phone Number: +41 223727460
- Email: Herve.Quintard@hcuge.ch
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
All adult patients suffering from non-traumatic subarachnoid haemorrhage.
Exclusion Criteria:
- Patients with major intra-cranial trauma
- Diagnosis of an AV-malformation as the source of subarachnoid hemorrhage on the primary CT/MRI or angiography
- More than 24 hours after diagnosis of subarachnoid haemorrhage as diagnosed by cerebral imaging (CT scan or MRI)
- Patients with clear limitation to therapy at hospital admission (eg ICU admission for evaluation of organ donation)
- Declining of informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: high sodium infusion fluid
Patients will exclusively receive 0.9% saline (sodium content 154mmol/l) for fluid maintenance and resuscitation from study inclusion until ICU/intermediate care (IMC) discharge.
|
We will compare two already established treatment protocols: the use of normal saline versus lactated Ringer's for fluid therapy in patients with subarachnoid hemorrhage.
|
Active Comparator: low sodium infusion fluid
Patients will exclusively receive lactated Ringer's (sodium content 130mmol/l) for fluid maintenance and resuscitation from study inclusion until ICU/intermediate care (IMC) discharge.
|
We will compare two already established treatment protocols: the use of normal saline versus lactated Ringer's for fluid therapy in patients with subarachnoid hemorrhage.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients with clinically relevant vasospasms
Time Frame: From ICU admission until discharge (usually within the first 21 days)
|
Defined as new neurologic deficit requiring immediate intervention
|
From ICU admission until discharge (usually within the first 21 days)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of ICU deaths
Time Frame: From ICU admission until discharge (usually within the first 21 days)
|
Death on the ICU
|
From ICU admission until discharge (usually within the first 21 days)
|
Number of In-hospital deaths
Time Frame: From hospital admission to hospital discharge (usually within the first 21 days)
|
Death during hospital stay
|
From hospital admission to hospital discharge (usually within the first 21 days)
|
Number of severe vasospasms requiring endovascular treatment
Time Frame: From hospital admission to hospital discharge (usually within the first 21 days)
|
Number of severe vasospasms requiring endovascular treatment
|
From hospital admission to hospital discharge (usually within the first 21 days)
|
Number of patients needing decompressive hemicraniectomy
Time Frame: From hospital admission to hospital discharge (usually within the first 21 days)
|
Operative intervention needed for high intracranial pressure
|
From hospital admission to hospital discharge (usually within the first 21 days)
|
Difference in modified RankingScale
Time Frame: At day 90 and 180
|
Scale ranges from 0-5 (0 = no symptoms; 5= severe disability)
|
At day 90 and 180
|
Difference in Glasgow Outcome Scale
Time Frame: At day 90 and 180
|
Scale ranges from 1-8 (1 is dead 7 good recovery)
|
At day 90 and 180
|
Difference in mini Montreal Cognitive Assessment
Time Frame: At day 90 and 180
|
Max score depends on age and education (the higher the score the better the cognition)
|
At day 90 and 180
|
Difference in Long-term mortality
Time Frame: At day 90 and 180
|
Death at 90 and 180 day
|
At day 90 and 180
|
Length of stay
Time Frame: ICU stay and hospital stay (usually between 1-30days)
|
Length of hospital stay
|
ICU stay and hospital stay (usually between 1-30days)
|
Collaborators and Investigators
Investigators
- Principal Investigator: Anna S Messmer, MD, Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- CRYSTALLBrain
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
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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