- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04580888
Emergency Echocardiography in Sepsis (GENESIS)
Impact of Early Haemodynamic Assessment by Echocardiography on Organ Dysfunction of Patients Admitted in the Emergency Department for Sepsis or Septic Shock
Study Overview
Status
Intervention / Treatment
Detailed Description
Sepsis is currently defined as life-threatening organ dysfunction secondary to a dysregulated host response to infection (Sepsis-3). Septic shock is a subgroup of patients who also have sustained arterial hypotension requiring vasopressors and tissue dysoxia. The mortality varies from 10 to 40% depending on the severity. The latest "bundles" of the SSC request to perform within the first hour of sepsis identification a fluid loading of 30 mL/kg of crystalloids in the presence of hypotension, and to initiate a vasopressor support in case of persistent hypotension to maintain a mean arterial pressure ≥ 65 mmHg. However, early fluid resuscitation is not necessarily associated with an improvement of sepsis prognosis and may even be deleterious when leading to excessive positive fluid balance. Accordingly, the SSC recommends investigating a personalized approach to define for each patient the appropriate volume of fluids to be administered according to the initial mechanism of sepsis-induced cardiovascular failure. Echocardiography is currently recommended as a first-line modality to identify the origin of acute circulatory failure, sepsis remaining the leading cause. It has been shown to alter ongoing treatment based on the sole SSC recommendations in the intensive care unit. In contrast, the impact of hemodynamic assessment using echocardiography at the early stage of sepsis in patients admitted to the Emergency Department (ED) is unknown.
In this randomized trial, patients will be either assessed hemodynamically using transthoracic echocardiography to guide early therapeutic management (intervention arm) or managed according to standards of care based on current SSC recommendations (control arm). Early echocardiography will be performed after 500 mL of fluid loading initiated upon identification of septic patients based on the qSOFA score (hemodynamic criterion required: systolic blood pressure ≤ 100 mmHg). This will allow identifying the hemodynamic profile at the origin of sepsis-induced circulatory failure and to monitor both the efficacy and tolerance of fluid resuscitation, or of any other therapeutic intervention (e.g., inotropic support) according to a predefined therapeutic algorithm. Patients allocated to the control arm will be managed conventionally according to current SSC recommendations, including a standardized fluid loading of 30 mL/kg.
Organ dysfunctions will be assessed in the two study arms by the SOFA score 24 hours after randomization and patient will be followed up until hospital discharge to determine outcome.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: LAFON Thomas, MD
- Phone Number: +33 555056254
- Email: thomas.lafon@chu-limoges.fr
Study Contact Backup
- Name: BOURZEIX Paul, MD
- Phone Number: +33 555058841
- Email: paul.bourzeix@chu-limoges.fr
Study Locations
-
-
-
Albi, France, 81000
- Recruiting
- CH d'Albi
-
Contact:
- Arthur BAISSE, MD
- Email: arthurbaisse@hotmail.com
-
Principal Investigator:
- Arthur BAISSE, MD
-
Bordeaux, France, 33076
- Withdrawn
- Bordeaux university hospital
-
Eaubonne, France, 95600
- Recruiting
- CH d'Eaubonne - Montmorency
-
Contact:
- Maxime GAUTIER, MD
- Phone Number: +33 134066755
- Email: maxime.gautier@ch-simoneveil.fr
-
Principal Investigator:
- Maxime GAUTIER, MD
-
La Tronche, France, 38700
- Recruiting
- Grenoble University Hospital
-
Contact:
- Damien VIGLINO, MD
- Phone Number: +33 476765934
- Email: dviglino@chu-grenoble.fr
-
Principal Investigator:
- DAMIEN VIGLINO, MD
-
Le Chesnay, France, 78150
- Recruiting
- Hopital de Versailles
-
Contact:
- Ludovic DALLE, MD
- Email: ldalle@ch-versailles.fr
-
Principal Investigator:
- Ludovic DALLE, MD
-
Limoges, France, 87042
- Recruiting
- Limgoes university hospital
-
Contact:
- LAFON Thomas, MD
- Phone Number: +33 555056254
- Email: thomas.lafon@chu-limoges.fr
-
Contact:
- BOURZEIX Paul, MD
- Phone Number: +33 555058841
- Email: paul.bourzeix@chu-limoges.fr
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Principal Investigator:
- LAFON Thomas, MD
-
Sub-Investigator:
- BAISSE Arthur, MD
-
Lyon, France, 69003
- Recruiting
- Hospices Civils de Lyon
-
Contact:
- Cécile DELAHAYE, MD
- Phone Number: +33 472119572
- Email: cecile.delahaye@chu-lyon.fr
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Principal Investigator:
- Cécile DELAHAYE, MD
-
Nantes, France, 44093
- Recruiting
- Nantes university hospital
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Contact:
- Philippe LE CONTE, MD
- Phone Number: +33 240083934
- Email: philippe.leconte@chu-nantes.fr
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Principal Investigator:
- Philippe LE CONTE, MD
-
Nice, France, 06600
- Recruiting
- Nice University Hospital
-
Contact:
- Julie CONTENTI, MD
- Phone Number: +33 492033242
- Email: contenti.j@chu-nice.fr
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Paris, France, 75010
- Recruiting
- Hôpital Lariboisière
-
Contact:
- Anthony CHAUVIN, MD
- Email: anthony.chauvin@aphp.fr
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Principal Investigator:
- Anthony CHAUVIN, MD
-
Poitiers, France, 86000
- Recruiting
- Poitiers university hospital
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Principal Investigator:
- Nicolas MARJANOVIC, MD
-
Contact:
- Nicolas MARJANOVIC, MD
- Phone Number: +33 549444444
- Email: nicolas.marjanovic@chu-poitiers.fr
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Saint-Pierre, France, 97410
- Recruiting
- La réunion university hospital
-
Contact:
- Adrien VAGUE, MD
- Phone Number: +33 693130226
- Email: adrien.vague@chu-reunion.fr
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Principal Investigator:
- Adrien VAGUE, MD
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Toulouse, France, 31059
- Recruiting
- Toulouse University Hospital
-
Contact:
- Frédéric BALEN, MD
- Phone Number: +33 561772379
- Email: balen.f@chu-toulouse.fr
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Principal Investigator:
- Frédéric BALEN, MD
-
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients admitted to the ED
- Age ≥ 18 years and affiliation to Social Security
- With sepsis (Sepsis-3 definition):
Clinically suspected or documented acute infection
AND a quick score Sequential Organ Failure Assessment (qSOFA) ≥ 2 points with:
- Systolic blood pressure ≤ 100 mmHg (1 point) requiring fluid loading
- AND encephalopathy (1 point) OR respiratory rate ≥ 22 cpm (1 point) AND a systolic blood pressure ≤ 100 mmHg after 500 mL of crystalloid vascular filling - Informed consent
Exclusion Criteria:
- Decision to limit care or moribund status
- Pregnancy or breast feeding
- Subject under juridical protection.
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 |
---|---|
Experimental: Intervention arm
Assessment using an early transthoracic echocardiography (after 500 mL of fluids) to identify the hemodynamic profile responsible for the acute circulatory failure associated with sepsis / septic shock and to guide ongoing treatment (therapeutic algorithm) and monitor its efficacy and tolerance.
|
In the intervention arm, echocardiography will be performed immediately and potentially repeated to confirm the need for additional fluid resuscitation up to 30 mL/kg in the presence of persisting hypovolemia, or not (e.g., severe ventricular dysfunction).
A therapeutic algorithm will allow standardized impact on ongoing management according to the hemodynamic profile identified by early echocardiography.
After the completion of initial fluid resuscitation up to 30 mL/kg if required, a new echocardiographic assessment will be systematically performed by the same operator to stop or not fluid resuscitation, and to potentially initiate another treatment according to both the hemodynamic profile and clinical context.
|
Other: Control arm
Conventional management according to current standards of care based on SSC recommendations, including a standardized fluid resuscitation of 30 mL/kg.
|
In the control arm, patients will be treated according to standards of care based on current SSC recommendations, including a fluid resuscitation of 30 mL/kg.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Sequential Organ Failure Assessment (SOFA) score
Time Frame: change from Hour 0 at Day 1
|
Crude variation of the SOFA score between inclusion and 24h following randomization.
|
change from Hour 0 at Day 1
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Interruption of fluid resuscitation
Time Frame: Hour 3
|
Number and proportion of patients in whom echocardiography performed in the ED (intervention arm) modified ongoing therapy based on SSC recommendations (standard of care) according to the hemodynamic profile.
Interruption of fluid resuscitation before having administrated 30 mL/kg
|
Hour 3
|
Maintains of fluid resuscitation
Time Frame: Hour 3
|
Number and proportion of patients in whom echocardiography performed in the ED (intervention arm) modified ongoing therapy based on SSC recommendations (standard of care) according to the hemodynamic profile.
Fluid resuscitation maintained beyond 30 mL/kg
|
Hour 3
|
Initiation of inotropes
Time Frame: Hour 3
|
Number and proportion of patients in whom echocardiography performed in the ED (intervention arm) modified ongoing therapy based on SSC recommendations (standard of care) according to the hemodynamic profile.
Initiation of inotropes
|
Hour 3
|
Initiation of vasopressor support
Time Frame: Hour 3
|
Number and proportion of patients in whom echocardiography performed in the ED (intervention arm) modified ongoing therapy based on SSC recommendations (standard of care) according to the hemodynamic profile.
Initiation of vasopressor support
|
Hour 3
|
Therapeutic modification
Time Frame: Hour 3
|
Number and proportion of patients in whom echocardiography performed in the ED (intervention arm) modified ongoing therapy based on SSC recommendations (standard of care) according to the hemodynamic profile.
Therapeutic modification directly related to the echocardiographic examination
|
Hour 3
|
Persisting hypovolemia
Time Frame: Hour 0
|
Number and proportion of patients presenting at the time of early hemodynamic assessment using echocardiography (intervention arm)
|
Hour 0
|
Left ventricular failure
Time Frame: Hour 0
|
Number and proportion of patients presenting at the time of early hemodynamic assessment using echocardiography (intervention arm)
|
Hour 0
|
Vasoplegia with left ventricular hyperkinesia
Time Frame: Hour 0
|
Number and proportion of patients presenting at the time of early hemodynamic assessment using echocardiography (intervention arm)
|
Hour 0
|
Right ventricular failure
Time Frame: Hour 0
|
Number and proportion of patients presenting at the time of early hemodynamic assessment using echocardiography (intervention arm)
|
Hour 0
|
Stabilized hemodynamic status
Time Frame: Hour 0
|
Number and proportion of patients presenting at the time of early hemodynamic assessment using echocardiography (intervention arm).
Stabilized hemodynamic status (none of above-mentioned abnormalities) due to adequate management of acute circulatory failure (avoid any deleterious therapeutic change).
|
Hour 0
|
Hydrostatic pulmonary edema
Time Frame: through study completion, an average of 1 month
|
Number of Hydrostatic pulmonary edema (cardiogenic or volume overload) since potentially related to excessive fluid loading
|
through study completion, an average of 1 month
|
Supraventricular arrhythmias
Time Frame: through study completion, an average of 1 month
|
Number of Supraventricular arrhythmias since potentially related to the initiation of positive inotropes
|
through study completion, an average of 1 month
|
ventricular arrhythmias
Time Frame: through study completion, an average of 1 month
|
Number of ventricular arrhythmias since potentially related to the initiation of positive inotropes
|
through study completion, an average of 1 month
|
acute coronary syndrome,
Time Frame: through study completion, an average of 1 month
|
Number of acute coronary syndrome since potentially related to the initiation of positive inotropes
|
through study completion, an average of 1 month
|
ischemic stroke
Time Frame: through study completion, an average of 1 month
|
Number of ischemic stroke since potentially related to the initiation of positive inotropes
|
through study completion, an average of 1 month
|
hemorrhagic stroke
Time Frame: through study completion, an average of 1 month
|
Number of hemorrhagic stroke since potentially related to the initiation of positive inotropes
|
through study completion, an average of 1 month
|
Lactate clearance
Time Frame: Hour 0 to Hour 6
|
Lactate clearance (lactate 6h after randomization compared to lactate at baseline)
|
Hour 0 to Hour 6
|
septic shock
Time Frame: Hour 24
|
Number and proportion of patients who developed septic shock 24 h after inclusion
|
Hour 24
|
Patient course
Time Frame: through study completion, an average of 1 month
|
Patient course after emergency department discharge: hospitalization in regular ward (medicine / surgery), stepdown unit or intensive care unit.
|
through study completion, an average of 1 month
|
Mortality
Time Frame: Day 7 and through study completion, an average of 1 month
|
Mortality (all-cause and sepsis-related) at Day 7 and at hospital discharge
|
Day 7 and through study completion, an average of 1 month
|
Collaborators and Investigators
Sponsor
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- 87RI19_0038 (GENESIS)
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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