- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04145271
Pre-Hospital Zone 1 Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Injured Patients With Exsanguinating Sub-diaphragmatic Haemorrhage (P-PRO)
Pre-Hospital Zone 1 Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Injured Patients With Exsanguinating Sub-diaphragmatic Haemorrhage (P-PRO-Study)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Haemorrhage (bleeding) is the most common cause of preventable death after injury and is responsible for approximately one-third of trauma deaths (of which between 16-29% of such deaths are thought to be preventable).
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive damage control procedure for life-threatening abdominal and/or pelvic haemorrhage. It involves temporary occlusion of the aorta with an endovascular balloon, providing proximal control to the site of vascular injury whilst supporting cerebral and myocardial perfusion.
Emergency Department (ED) use of REBOA appears to be feasible and associated with improved outcomes. However, bleeding trauma patients die quickly and it's evident that the peak death rate from haemorrhage occurs within 30 minutes of injury. This is well before the majority of patients can reach hospital, it's therefore likely this resuscitation strategy may have greatest benefit for patients when used in the pre-hospital environment.
We have demonstrated that Pre-Hospital Zone III REBOA (distal aortic occlusion) for exsanguinating pelvic haemorrhage is a feasible resuscitation strategy that significantly improves blood pressure and may reduce the risk of hypovolaemic cardiac arrest and early death due to exsanguination.
To evolve this resuscitation strategy, it is important to establish whether it can be delivered in patients with more proximal haemorrhage in the abdomen (Zone I REBOA). However, this development may be associated with increased risk of harm due to the visceral ischaemia that is created. The use of a technique called Partial REBOA (P-REBOA) may offer a solution by mitigating the ischaemia/reperfusion injury created.
It is unknown whether this evolved strategy (Zone I P-REBOA) is feasible in the pre-hospital setting. This study therefore aims to establish via an Observational Cohort of eight adult trauma patients whether Zone I P-REBOA can be achieved in pre-hospital resuscitation of adult trauma patients with exsanguiunating sub-diaphragmatic haemorrhage at risk of imminent hypovolaemic cardiac arrest or recent hypovolaemic cardiac arrest.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
-
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London, United Kingdom, E1 1FR
- Royal London Hospital
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London, United Kingdom, E1
- London HEMS
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London, United Kingdom, SW17 0QT
- St. Georges Hospital
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London, United Kingdom, W2 1NY
- St.Marys Hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria -
- Adult trauma patients (aged, or believed to be aged 16 years or older) attended by LAA;
- assessed to have exsanguinating sub-diaphragmatic haemorrhage and imminent risk of hypovolaemic cardiac arrest, or recent hypovolaemic cardiac arrest;
- which is thought to be amenable to treatment with Zone I REBOA;
- and an attempt is made at femoral arterial access (percutaneous access or open surgical approach to insert 8Fr REBOA access sheath)
Exclusion Criteria -
- Age < 16 years
- Injuries deemed clinically unsurvivable
- Known or visible advanced pregnancy
Study Plan
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Prospective
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Zone 1 REBOA
Time Frame: 1 day
|
The proportion of patients where Pre-Hospital Zone 1 REBOA is achieved, defined as:
|
1 day
|
Partial REBOA (P-REBOA)
Time Frame: 1 day
|
The proportion of Pre-Hospital Zone 1 REBOA patients where P-REBOA is achieved, defined as:
|
1 day
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
• Incidence of Zone I balloon positioning in the ED
Time Frame: 1 Days
|
On routinely performed plain film chest X-Ray.
Defined as balloon positioned between T4 - L1 and/or distal to carina, proximal to diaphragm) or on CT.
|
1 Days
|
• Incidence of pre-hospital balloon migration
Time Frame: 1 Day
|
(>2cm from the recorded insertion depth, reported by the pre-hospital clinical team
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1 Day
|
• Incidence of balloon repositioning (proximal or distal) pre or in-hospital.
Time Frame: 1 Day
|
Repostioned in aorta for clinical reason
|
1 Day
|
• Method of achieving Partial REBOA
Time Frame: 1 Day
|
Balloon deflation, spontaneous, or straight to P-REBOA.
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1 Day
|
• Incidence of failed femoral arterial access
Time Frame: 1 Day
|
Inability to successfully cannulate the CFA percutaneously or via an open approach.
|
1 Day
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• Time elapsed from balloon inflation to the institution or recognition of P-REBOA.
Time Frame: 1 Day
|
Temporal
|
1 Day
|
• Incidence of balloon reinflation or the requirement for additional balloon volume, post institution or recognition of P-REBOA.
Time Frame: 1 Day
|
For clinical reason.
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1 Day
|
• Total duration of REBOA (inflation to final deflation).
Time Frame: 1 Day
|
Temporal
|
1 Day
|
• Systolic blood pressure response to institution of REBOA
Time Frame: 1 day
|
Physiological
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1 day
|
• Incidence of pre-hospital cardiac arrest
Time Frame: 1 day
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Pre and post REBOA, absent carotid or central pulse.
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1 day
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• Incidence of pre-hospital, ED, or operating theatre resuscitative thoracotomy (RT).
Time Frame: 1 Day
|
RT
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1 Day
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• Mortality rate - Pre-hospital, one hour, 3 hours, 24 hours, 30 and 90 days.
Time Frame: 90 days.
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Mortality
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90 days.
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• Causes of death (in-hospital and pre-hospital) of patients who received Pre-Hospital REBOA or did not following a failed attempt.
Time Frame: 1 year
|
This will be determined by the SMG following review of all the routinely available clinical information (CT scan results, operative findings and post-mortem findings).
|
1 year
|
• Survival to hospital discharge.
Time Frame: 90 Days
|
Survival
|
90 Days
|
• Length of critical care and hospital stay.
Time Frame: 90 Days
|
Temporal
|
90 Days
|
• Incidence of all adverse events related to patient injury, resulting critical illness and treatment as well as femoral cannulation, REBOA catheter insertion and/or the anticipated effects of aortic occlusion:
Time Frame: 90 Days
|
|
90 Days
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
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
- 271728
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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