- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05505422
Routine Versus Selective Intraoperative ECMO in Lung Transplant
Randomized Trial of Routine Versus Selective Use of Intraoperative Extracorporeal Mechanical Support During Lung Transplantation : a Pilot Study
Intraoperative hemodynamic management is vital in the success of lung transplantation. Significant intraoperative hemodynamic compromise and hypoxic episodes may contribute to an increase in severe postoperative complications related to hypoperfusion, including cerebrovascular accidents, acute kidney injury, and mesenteric ischemia. In certain lung transplant recipients, intraoperative cardiopulmonary support is mandatory because certain factors would make "off-pump" transplants unsafe. These include severe pulmonary hypertension or severe ventricular dysfunction. In such patients, routine intraoperative support should be employed. However, it is possible to conduct the lung transplant without cardiopulmonary support in the remainder of patients who do not have severe pulmonary hypertension or right heart dysfunction. In such patients, the lung transplant may be started without cardiopulmonary support. However, cardiopulmonary support may be initiated "on-demand" if there is development or impending hemodynamic embarrassment or hypoxia. Conversely, the opposite approach would be to routinely conduct all lung transplant operations using cardiopulmonary support, which may also lead to specific ECMO-related complications.
The investigators question whether on demand intraoperative ECMO in patients with significant risk factors will produce severe postoperative complications in a rate similar to routine ECMO.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Hypothesis: In patients where cardiopulmonary bypass (CPB) / ECMO is not mandatory, on-demand use of intra-operative ECMO is equivalent to routine use for patients undergoing lung transplant.
The study will be a prospective, randomized controlled trial. The investigators seek to compare outcomes of two different strategies of cardiopulmonary support during lung transplantation; routine support with ECMO versus selective (on-demand), indication- based support with ECMO. The allocation ratio will be 1:1. A multi-center trial is necessary to allow for a sufficient sample size. However, the investigators believe a pilot study is essential to determine feasibility before embarking on such a significant undertaking.
In this preliminary pilot study, recruitment will be limited to lung transplant patients at the Centre hospitalier de l'Universite de Montreal (CHUM). The primary purpose of the pilot study will be to define recruitment ability and assess the feasibility of conducting the study. Depending on the results of this pilot study, the next step would be to expand the study to multiple lung transplant centers to achieve an adequate sample size and power, allowing the investigators to answer the question of interest.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Basil Nasir, MD
- Phone Number: 24543 514-890-8000
- Email: basilsnasir@gmail.com
Study Contact Backup
- Name: Alex Moore, MD
- Phone Number: 12171 514-890-8000
- Email: alex.moore@umontreal.ca
Study Locations
-
-
Quebec
-
Montreal, Quebec, Canada, H2X3E4
- Centre Hospitalier de l'Universite de Montreal
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Patients undergoing lung transplant surgery during the study period (6 months)
Exclusion Criteria:
- Inability to provide consent for the study or patient refusal
- Retransplantation
- Multi-organ transplantation
Lung transplant recipients where intraoperative support is mandatory and "off- pump" transplant would be unsafe:
a. Severe pulmonary hypertension (PH):
i. Systolic pulmonary artery pressure (PAP) ≥ 80 mm Hg on echocardiography, right heart catheterization, or pulmonary artery catheter measurement
ii. Mean PAP ≥ 55 mm Hg on echocardiography, right heart catheterization, or pulmonary artery catheter measurement
iii. The ratio of mean pulmonary to systemic artery pressure of more than 0.66
b. Moderate to severe right ventricular (RV) hypokinesis or dysfunction
c. Left ventricular dysfunction: Defined as ejection fraction (LVEF) < 50% on echocardiography, ventriculography, computed tomography (CT), or magnetic resonance imaging (MRI)
d. Significant coronary artery disease (CAD)requiring stenting or surgical grafting
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: On demand ECMO (study group)
|
Selective, indication-based intraoperative cardiopulmonary support. In this group, the transplant will be planned without cardiopulmonary support. intraoperative ECMO will be used selectively based on hemodynamic and/or gas exchange abnormalities :
|
Active Comparator: Routine ECMO (control group)
|
Routine ECMO during lung tansplant
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Study recruitment rate
Time Frame: 6 months after the onset of study
|
6 months after the onset of study
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Percentage of patients loss to follow-up
Time Frame: 1 year
|
1 year
|
The composite incidence of death, disabling stroke, grade 2 or 3 primary graft dysfunction at 72 hours, major bleeding (BARC grade 3a, 3b or 5), vascular complications, or stage II or III acute kidney injury at 14 days.
Time Frame: 14 days
|
14 days
|
Incidence of all-cause mortality at 30 days, 90 days, and one year
Time Frame: 1 year
|
1 year
|
Incidence of postoperative stroke / cerebrovascular accident
Time Frame: 14 days
|
14 days
|
Incidence of an Early major postoperative neurologic complication (EMPNC): This includes stroke, severe encephalopathy, and severe seizures diagnosed within 14 days after surgery.
Time Frame: 14 days
|
14 days
|
Incidence of severe postoperative complications. This is defined as Clavien-Dindo grade III complication or greater
Time Frame: 14 days
|
14 days
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence and grade of primary graft dysfunction (PGD) at 0, 24, 48, and 72 hours
Time Frame: From the end of surgery up to 72 hours after surgery
|
From the end of surgery up to 72 hours after surgery
|
|
Incidence of postoperative bleeding complications. The definition of bleeding complication is based on Bleeding Academic Research Consortium (BARC) classification
Time Frame: 14 days after surgery
|
14 days after surgery
|
|
Intraoperative blood product transfusion requirements
Time Frame: From the beginning of surgery to transfer to the intensive care unit
|
From the beginning of surgery to transfer to the intensive care unit
|
|
Perioperative blood product transfusion requirements
Time Frame: 14 days
|
From the beginning of surgery to 14 days after surgery, including return to the operating room for subsequent surgeries
|
14 days
|
Intensive care unit and hospital length of stay in days
Time Frame: Beginning from the arrival to the intensive care unit immediately after surgery
|
Beginning from the arrival to the intensive care unit immediately after surgery
|
|
Duration of mechanical ventilation in hours
Time Frame: Beginning from the arrival to the intensive care unit immediately after surgery, up to about 30 days
|
BiPAP and CPAP are not considered mechanical ventilation.
Tracheostomy is not considered mechanical ventilation if a ventilator is not needed.
|
Beginning from the arrival to the intensive care unit immediately after surgery, up to about 30 days
|
Incidence of re-intubation
Time Frame: 14 days
|
14 days
|
|
Incidence of postoperative tracheostomy
Time Frame: 21 days
|
21 days
|
|
Incidence of acute kidney injury (AKI) within 14 days. The definition of AKI is based on Kidney Disease; improving global outcomes (KDIGO) classification
Time Frame: 14 days
|
14 days
|
|
Incidence of vascular complications
Time Frame: 14 days
|
14 days
|
|
Forced expiratory volume at 1 second (FEV1) at 1 year
Time Frame: 1 year
|
1 year
|
|
Incidence of stroke
Time Frame: 1 year
|
1 year
|
|
Incidence of acute rejection episodes
Time Frame: 1 year
|
1 year
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Anticipated)
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
- 2023-10663
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.
Clinical Trials on Postoperative Complications
-
Marmara UniversityHacettepe University; Cukurova University; Gazi University; Baskent University; Istanbul... and other collaboratorsNot yet recruitingComplications, PostoperativeTurkey
-
Syed HusainRecruitingComplications, PostoperativeUnited States
-
Vastra Gotaland RegionRecruitingSurgery | Lung Infection | Complications, PostoperativeSweden
-
University of PittsburghCompletedLiver Transplant; Complications | Perioperative/Postoperative ComplicationsUnited States
-
Washington University School of MedicineNational Institute of Nursing Research (NINR)CompletedSurgery | Surgery--Complications | Perioperative/Postoperative ComplicationsUnited States
-
Wake Forest University Health SciencesTerminatedPerioperative/Postoperative ComplicationsUnited States
-
Technical University of MunichHealth Information Management, BelgiumActive, not recruitingPerioperative/Postoperative Complications
-
Atatürk Chest Diseases and Chest Surgery Training...CompletedPerioperative/Postoperative ComplicationsTurkey
-
Namigar TurgutCompletedPerioperative/Postoperative ComplicationsTurkey
-
TC Erciyes UniversityCompletedPerioperative/Postoperative ComplicationsTurkey
Clinical Trials on On demand ECMO
-
University of UtahNational Institute of Nursing Research (NINR)RecruitingPostpartum Depression | Perinatal DepressionUnited States
-
Franciscus GasthuisJeroen Bosch ZiekenhuisNot yet recruitingInflammatory Bowel Diseases | Self Efficacy | Patient Empowerment | Telemonitoring
-
IsalaCompletedChronic Obstructive Pulmonary DiseaseNetherlands
-
Assistance Publique - Hôpitaux de ParisMaquet CardiovascularCompletedCardiac Arrest | Sudden DeathFrance
-
University of BergenEuropean Society of Intensive Care MedicineWithdrawnPTSD | Depression, Anxiety | Intensive Care Unit Syndrome | Caregivers | Functionally-Impaired Elderly
-
Acibadem UniversityCompletedPostoperative Nausea and Vomiting | Patient Satisfaction | Feeding Patterns | Cesarean DeliveryTurkey
-
Mohammed VI University HospitalCompletedSARS CoV 2 Infection | Hypoxemic Respiratory FailureMorocco
-
Ohio State UniversityCompletedInfant Death | Pregnancy PretermUnited States
-
Philips Electronics Nederland B.V. acting through...CompletedNeuromuscular DiseasesNetherlands
-
Mohammed VI University HospitalCompletedMortality | Incidence of CRRT With ECMO Therapy | and Renal RecoveryMorocco