- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04896736
Multisite Tissue Oxygenation Guided Perioperative Care in Cardiac Surgery (BOTTOMLINECS)
Multisite Tissue Oxygenation Guided Perioperative Care to Reduce Composite Complications in Cardiac Surgical Patients: the BOTTOMLINE-CS Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Short title: BOTTOMLINE-CS trial Methodology: International, open, single-center, pragmatic, randomised controlled trial Research sites: Tianjin Chest Hospital Objectives: To investigate whether multisite tissue oxygen saturation monitoring-guided perioperative care reduces composite complications within 30 days of randomization in off-pump coronary artery bypass grafting Number of patients: 1960 patients (980 per arm, two arms) Inclusion criteria: Patients aged ≥ 60 years undergoing elective off-pump coronary artery bypass grafting Exclusion criteria: Patient refusal, clinician refusal, preoperative requirement of respiratory support (intubation, CPAP or BiPAP, or high-flow oxygen (>10 L/min)), preoperative requirement of external cardiac assist devices, emergent or urgent surgery, patients expected to die within 30 days, current participation in another clinical trial Statistical analysis: Analyses will be performed on a modified intention-to-treat basis including all randomized patients who had undergone the scheduled surgery and had the record of the primary outcome. Summary statistics for each group, treatment effects, 95% confidence intervals, and p values will be presented for primary and secondary outcomes, and process measures. The primary outcome is a composite of complications arising within 30 days from randomization and will be analyzed using a logistic regression model.
Proposed start date: May 1, 2021 (First patient to be recruited) Proposed end date: April 30, 2023 (Last patient to be recruited) Study duration: 48 months (Starting from the first patient recruitment, spanning patient recruitment, data analysis, and manuscript writing and submission)
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Lingzhong Meng
- Phone Number: 12037852802
- Email: menglz@iu.edu
Study Locations
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Tianjin
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Tianjin, Tianjin, China
- Tianjin Chest Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients aged ≥ 60 years scheduled for elective off-pump CABG.
Exclusion Criteria:
- Inability or refusal to provide consent of participation
- Preoperative requirement of respiratory support (intubation, CPAP or BiPAP, or high-flow oxygen (>10 L/min))
- Preoperative requirement of external cardiac assist device
- Urgent or emergent surgery
- Patients expected to die within 30 days of randomization
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Multisite tissue oxygenation monitoring-guided care
Details are as follows. • Monitoring: SctO2 monitored using two probes placed on left and right forehead. SstO2 monitored using one probe placed over the forearm brachioradialis muscle on the arm not used for non-invasive blood pressure monitoring. • Baseline: The first baseline is measured 12-48 hours before surgery, with the patient supine, awake, calm, eyes closed, and breathing room air or oxygen that is equivalent to the home oxygen rate for patients using home oxygen.
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The following intervention algorithm is intended to be used as a guidance only. We emphasize the different aspects that can cause changes in SctO2/SstO2 in a systematic approach. We avoid recommending a concrete drug and method of dosing for a specific condition. Manage tissue perfusion Preload: overall picture including direct observation of the heart, findings of echocardiography, urine output, blood loss, labs results, HR, BP, PPV, SVV, fluid responsiveness (SV increase >/= 10% following 250 ml fluid bolus) Contractility: direct observation of the heart, findings of echocardiography Stroke volume and heart rate: important determinants of CO Systemic vascular resistance: important determinant of BP Regional vascular resistance: important determinant of tissue perfusion along with perfusion pressure Maintain autoregulation: normalize CO2, avoid potent vasodilators Manage arterial blood oxygen content Manage tissue metabolic activity |
Active Comparator: Usual care
Patients in the control group will be managed by clinical staff according to usual care.
Patients in this group will be monitored using the same tissue oximeter used in the intervention group; however, the screen will be covered by an opaque cloth to prohibit the care givers seeing the monitoring data.
The same baseline measurements will be performed in patients allocated to the usual care group.
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Usual care in this study means the standard perioperative care.
Patients who are meant to receive usual care will receive both cerebral and muscular tissue oxygen saturation monitoring; however, the monitor screen will be covered and the monitoring data will not be used to guide clinical care.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Composite complication
Time Frame: from the day of surgery (i.e., day 0) until postoperative day 30 for a total of 31 days (individual components may vary)
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The primary outcome is a collapsed (one or more) composite of the following complications with a Clavien-Dindo grade II or greater arising within 30 days of randomization (randomization and surgery are performed on the same day). The patient is regarded as having the event of composite complications if any of the following complications occur (i.e., yes); otherwise, the patient is regarded as not having the event of composite complications. The percentage of patients having the event of composite complications will be used in the primary analysis.
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from the day of surgery (i.e., day 0) until postoperative day 30 for a total of 31 days (individual components may vary)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Atrial fibrillation
Time Frame: from the day of surgery until postoperative day 30
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Atrial fibrillation A new diagnosis of AF per the current standard. |
from the day of surgery until postoperative day 30
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Postoperative delirium
Time Frame: from postoperative day 1 throughout postoperative day 5
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Postoperative delirium (assessed using CAM-ICU Worksheet for patients in PACU and ICU, or CAM for patients on the floor). The validated Chinese version will be used for assessment. Delirium will be formally assessed as early in the morning as practical and early evening for the initial five postoperative days while patients remain hospitalized because this approach will detect nearly all postoperative delirium. Observed daytime delirium will be recorded and considered as an outcome. Delirium will not be evaluated the evening after surgery because confusion might result from residual anesthetic effects. |
from postoperative day 1 throughout postoperative day 5
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Postoperative cognitive decline
Time Frame: Assessed before surgery, on postoperative day 5 and 30
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Postoperative cognitive decline (assessed using 30-points MoCA 7.1 version). The validated Chinese version will be used. MoCA evaluates multiple cognitive domains including executive function and is widely used. Validated versions of MoCA are available in many languages including Chinese and German. A decrease of ≥2 points is associated with cognitive decline based on formal neuropsychological testing and considered a clinically meaningful reduction. |
Assessed before surgery, on postoperative day 5 and 30
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Length of hospital stay
Time Frame: from the day of surgery (day 0) until hospital discharge or until day 30, whichever occurs first
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Length of hospital stay in days
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from the day of surgery (day 0) until hospital discharge or until day 30, whichever occurs first
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Perioperative stroke
Time Frame: Stroke will be assessed from the day of surgery throughout postoperative day 30
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Any stroke per current clinical diagnostic criteria arising during surgery or after surgery until postoperative day 30.
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Stroke will be assessed from the day of surgery throughout postoperative day 30
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Cardiac complications (one component of the primary outcome)
Time Frame: from the day of surgery (i.e., day 0) until postoperative day 30 for a total of 31 days
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Cardiac complications include:
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from the day of surgery (i.e., day 0) until postoperative day 30 for a total of 31 days
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Respiratory failure (one component of the primary outcome)
Time Frame: from the day of surgery (i.e., day 0) until postoperative day 30 for a total of 31 days
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Respiratory failure is defined as the requirement of respiratory support (intubation, CPAP or BiPAP, or high-flow oxygen (>10 L/min)) for acute respiratory insufficiency for more than 6 hours after surgery.
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from the day of surgery (i.e., day 0) until postoperative day 30 for a total of 31 days
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Renal complications (one component of the primary outcome)
Time Frame: from the postoperative day 1 until postoperative day 7 for a total of 7 days
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Renal complications in this study refers to acute Kidney Injury stages II and III diagnosed using the Kidney Disease Improving Global Guidelines (KDIGO).
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from the postoperative day 1 until postoperative day 7 for a total of 7 days
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Infectious complications (one component of the primary outcome)
Time Frame: from postoperative day 1 until postoperative day 30 for a total of 30 days
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Infectious complications include the following:
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from postoperative day 1 until postoperative day 30 for a total of 30 days
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Jiange Han, Tianjin Chest Hospital
Publications and helpful links
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2021KY-008-01
- 000 (Other Identifier: CTGTY)
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
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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