- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04197700
The PRESSURE CABG Cardiac Surgery Trial (PRESSURECABG)
PRotocolized vs pErsonalized Blood preSSUre peRi-operative paramEters in Coronary Artery Bypass Grafting Surgery: The PRESSURE CABG Cardiac Surgery Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Personalized Arm: The target MAP will be defined as +10% of the resting MAP. Resting MAP will be defined in priority order using one of the following MAP measurements:
- Pre-operative anesthesia or surgical consultation;
- Other physician outpatient consultation (e.g. cardiology, family physician, internist) within 30 days of surgery;
- Inpatient measurement the night before surgery;
- Pre-anesthetic MAP
The lower and upper safety limits of personalized MAP targets will be 50mmHg and <90mmHg, respectively.
Protocolized Arm: The target MAP will be defined as 65 +/- 5mmHg. Pharmacologic and fluid treatment decisions will be at the discretion of the most responsible physician.
In both study arms, the blood pressure control period will extend from anesthetic induction until 12 hours after admission to the CSICU. As an additional safety metric, the anesthesiologist will be encouraged to utilize clinically-driven cerebral saturation monitoring to identify potential hypoperfusion. In cases with low bilateral saturations where the anesthesiologist feels low MAP may be the putative mechanism, the investigators will request that MAPs be raised in 5mmHg increments. Following completion of the study protocol, the MAP and/or systolic blood pressure targets will be at the discretion of the most responsible physician.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Sean van Diepen, MD
- Phone Number: 780-407-6948
- Email: sv9@ualberta.ca
Study Contact Backup
- Name: Karin Kushniruk, RN, PhD
- Phone Number: 7 1-800-707-9098
- Email: karin.kushniruk@ualberta.ca
Study Locations
-
-
Alberta
-
Edmonton, Alberta, Canada, T6G 2B7
- Recruiting
- University of Alberta Hospital
-
Contact:
- Sean van Diepen, MD
- Phone Number: 780-407-6948
- Email: sv9@ualberta.ca
-
Contact:
- Karin Kushniruk, RN, PhD
- Phone Number: 1-800-707-9098 Ext. 7
- Email: karin.kushniruk@ualberta.ca
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- All patients > or = to 18 years of age undergoing non-emergent CABG
Exclusion Criteria:
- Pre-induction use of intravenous inotrope, vasopressor, or vasodilator
- Re-operation during the index hospital stay
- Non-CABG valvular or aortic surgery
- *Patients with end-stage renal disease or pre-operative AKI (defined as in-hospital increase in creatinine by >50%) will be excluded from the renal outcomes but included in the analysis of secondary outcomes
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Personalized Arm
Personalized Arm: The target MAP will be defined as +/- 5% of the resting MAP. Resting MAP will be defined in priority order using one of the following MAP measurements:
The order of the measurements prioritizes outpatient MAPs given that temporary pre-operative discontinuation of anti-hypertensive agents could potentially raise, while fasting and/or fluid restriction pre-operatively could potentially lower resting blood pressure.39 The lower and upper safety limits of personalized MAP targets will be 50mmHg and <90mmHg, respectively. |
Target MAP Management
|
Other: Protocolized Arm
Protocolized Arm: The target MAP will be defined as 65 +/- 5mmHg. Pharmacologic and fluid treatment decisions will be at the discretion of the most responsible physician. In both study arms, the blood pressure control period will extend from anesthetic induction until 12 hours after admission to the CSICU. As an additional safety metric, the anesthesiologist will be encouraged to utilize clinically-driven cerebral saturation monitoring to identify potential hypoperfusion. In cases with low bilateral saturations where the anesthesiologist feels low MAP may be the putative mechanism, the investigators will request that MAPs be raised in 5mmHg increments. Following completion of the study protocol, the MAP and/or systolic blood pressure targets will be at the discretion of the most responsible physician. |
Target MAP Management
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Composite of delirium or AKI
Time Frame: within 7 days of surgery
|
composite of delirium(defined as Intensive care delirium screening checklist score >=4) or Acute kidney injury (defined as a >=50% rise in serum creatinine)m
|
within 7 days of surgery
|
Re-operation for bleeding
Time Frame: Within 7 days of surgery
|
re-operation for bleeding
|
Within 7 days of surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Delirium
Time Frame: Through 7 days
|
Incidence (defined as Intensive care delirium screening checklist score >=4) and duration of Delirium (in days)
|
Through 7 days
|
The incidence of Stroke
Time Frame: Up to the time of hospital discharge, estimated average 5 days
|
post-operative stroke
|
Up to the time of hospital discharge, estimated average 5 days
|
Renal Outcomes
Time Frame: Up to the time of hospital discharge, estimated average 5 days
|
Risk of Acute kidney injury, Acute Kidney Injury, Renal Failure, Renal replacement therapy according to RIFLE criteria
|
Up to the time of hospital discharge, estimated average 5 days
|
Difference in peak median creatinine levels
Time Frame: Up to the time of hospital discharge, estimated average 5 days
|
Absolute difference in peak median creatinine levels
|
Up to the time of hospital discharge, estimated average 5 days
|
Chest tube output
Time Frame: Through 48 hours post-op
|
Median differences in chest tube output
|
Through 48 hours post-op
|
Blood Products
Time Frame: Through 48 hours post-operatively
|
Number of red blood cell, fresh frozen plasma, and platelet transfusions
|
Through 48 hours post-operatively
|
IV Vasoactive Support
Time Frame: Up to the time of ICU discharge, , estimated average 2 days
|
Median duration of intravenous vasoactive support
|
Up to the time of ICU discharge, , estimated average 2 days
|
Vasoactive support >24hrs
Time Frame: Up to 25 hours post-operatively
|
Percentage of patients with vasoactive support >24 hours
|
Up to 25 hours post-operatively
|
Mechanical Ventilation
Time Frame: Up to the time of ICU discharge, estimated average 4 hours
|
Duration of mechanical ventilation
|
Up to the time of ICU discharge, estimated average 4 hours
|
Length of Stay
Time Frame: Up to the time of ICU discharge, estimated average 2 days
|
Duration of CSICU stay
|
Up to the time of ICU discharge, estimated average 2 days
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Sean van Diepen, MD, University of Alberta
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
- Pro00095074
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
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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