- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06179771
Pilot Study on HA380 Column Use in Critically Ill Patients Receiving Extracorporeal Support. (HACEC)
HA380 Column Use in Critically Ill Patients Receiving Extracorporeal Support for Acute Critical Illness; a Prospective, Randomised, Interventional, Feasibility, Pilot Study (HACEC)
Study Overview
Status
Intervention / Treatment
Detailed Description
The role of inflammation in the pathophysiology of major organ dysfunction in critically ill patients is well established and this correlates with the degree of organ dysfunction which consequently may require increased level of organ support in the intensive care unit. Critically ill patients present in a spectrum of inflammatory states and on the extreme end of this spectrum are patients requiring renal replacement therapy and ECMO support. This subgroup of critically ill patients have been found to have high mortality.
The concept of attenuating severe hyperinflammatory response is sometimes used in certain disease states using agents such as intravenous corticosteroids, plasma exchange and more recently, anti-cytokine monoclonal antibodies. However, these strategies are associated with side effects (e.g. Bleeding and increased risk of infection), and are not necessarily appropriate in all critically ill patients with severe inflammation. Studies investigating the efficacy of these strategies have failed to show any clinical benefit except in the setting of COVID 19 infection.1-4 Early use of cytokine adsorption devices may provide an alternative non- pharmacological pathway with fewer side effects which can be deployed early.
The most studied cytokine adsorption device is the CytoSorb column which consists of biocompatible polymer sorbent beads. Several studies have demonstrated a reduction in vasopressor requirements, IL-6 levels, and Sequential Organ Failure Assessment (SOFA) scores.5,6 However, this observation did not translate into outcome benefit. There is considerable heterogeneity in how the cytokine adsorption is delivered in these studies and the study designs. An international registry analysis did not demonstrate a mortality benefit with CytoSorb either.7
The HA380 column consists of styrene divinylbenzene copolymers. In a recent study consisting of patients undergoing cardio-pulmonary bypass, patients who received the HA 380 column required lower vasopressor doses, shorter duration of invasive mechanical ventilation and had a shorter ICU length of stay.8 A direct in- vitro comparison of the CytoSorb device and the HA 380 device shows that the latter is less efficient at removing cytokines compared to the CytoSorb device but both devices were efficient at removing pro-inflammatory cytokines.9 The role of cytokines in critical illness is a double-edged sword10, and this may well be where CytoSorb may have a disadvantage - providing higher cytokine clearance for a longer period.
We hypothesise that the HA380 column use in critically ill patients with inflammation receiving renal replacement therapy or ECMO is associated with an improvement in mortality. It is recommended to be used early (within 72 hours of commencement of extracorporeal support). HA380 hemoperfusion cartridge, mainly adsorbs molecules from 10 to 60 kDa. Because of the accurate 3D macroporous structure and over 54000 m2 adsorption surface area of the resin.HA380 haemoperfusion therapy can provide a new regimen in controlling inflammatory cytokines storm. Studies have demonstrated the ability of the HA380 column to reduce the concentration of pro-inflammatory cytokines IL-1, TNF-alpha. 11,12
The aim of this feasibility pilot is to assess the feasibility of the early use of the HA380 cytokine adsorption column in a study and its effect on the time-to-liberation from extracorporeal membrane oxygenation (ECMO) support, vasoactive drug requirement and duration of vasoactive therapy, and mortality (or clinical surrogates for all-cause mortality).
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Hakeem Yusuff, MBBS
- Phone Number: 01162583816
- Email: hakeem.yusuff1@nhs.net
Study Locations
-
-
Leicestershire
-
Leicester, Leicestershire, United Kingdom, LE3 9QP
- Recruiting
- University Hospitals of Leicester NHS Trust
-
Contact:
- Hakeem O Yusuff, MBBS
- Email: hakeem.yusuff1@nhs.net
-
Contact:
- Vasileios Zochios, MD
- Email: vasileioszochios@doctors.org.uk
-
Principal Investigator:
- Matthew Charlton, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria
- Consent obtained
- Male or Female, aged 18 years - 65 years.
- Admitted with a diagnosis of sepsis (according to sepsis-3 definition), trauma, ARDS of infectious or non-infectious aetiology, trauma or after major surgery
- Need for extracorporeal support and specifically renal replacement therapy (RRT) and/or ECMO.
- Vasopressor or inotropic therapy requirement at the time of RRT or ECMO support
- Within 72 hours of requiring extracorporeal support
- At least one of:
- CRP > 100 mg/L (in the absence of immunosuppressive therapy/immunomodulation)
- Lactate >2 mmol/L
Exclusion Criteria
- The participant may not enter the trial if ANY of the following apply:
- Unable to obtain consent.
- Expected to die in the next 24 hours.
- Pre-existing chronic kidney disease - requiring dialysis /eGFR < 30ml/min/1.73m2
- Pre-existing severe respiratory failure - e.g., requiring home oxygen/ home nebulisers/ poor exercise tolerance
- Chronic heart failure - NYHA class III and above
- Pregnancy
- Requirement for immediate immune modulation e.g., plasma exchange, high dose steroids , IV immunoglobulins (does not include vasoplegic dose of steroids or immune modulation for COVID 19)
- Participants who have participated in another research trial involving an investigational product in the past 12 weeks.
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 |
|---|---|
|
Active Comparator: Interventional
Patients assigned to interventional arm will receive treatment with a cytokine adsorption device (HA 380) within 72 hours of being admitted to ICU.
This is in addition to standard evidence based ICU care.
Each patient will receive 2 treatments each lasting a maximum of 6 hours in a 24 hour period.
|
HA380 hemoperfusion cartridge is filled with neutral macroporous resin, mainly adsorbing molecules from 10 to 60 kDa.
Because of the accurate 3D macroporous structure and over 54000 m2 adsorption surface area of the resin.
The cartridge is attached to the extracorporeal circuit in series with the oxygenator/ filter of the extracorporeal circuit.
|
|
No Intervention: Standard care
Patients assigned to the standard care arm would receive evidence based standard ICU care.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Successful use of HA380 column in critically ill patients.
Time Frame: through study completion, an average of 24 months
|
Number of patients unable to tolerate treatment with HA380 column.
|
through study completion, an average of 24 months
|
|
Ability to recruit the sample size of eligible patients within the study period.
Time Frame: through study completion, an average of 24 months
|
Proportion of the sample size recruited into the study during the study period.
|
through study completion, an average of 24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Time spent on vasopressor therapy.
Time Frame: From date admission to ICU, assessed up to 4 weeks
|
Hours spent requiring vasopressor support.
|
From date admission to ICU, assessed up to 4 weeks
|
|
Time spent in ICU
Time Frame: From date of admission to ICU until the date of ICU discharge or date of death, which ever comes first, assessed up to 24 months
|
Days spent in ICU
|
From date of admission to ICU until the date of ICU discharge or date of death, which ever comes first, assessed up to 24 months
|
|
ICU Mortality
Time Frame: From the date of admission to ICU until the date of death from any cause during ICU stay, assessed up to 24 months
|
Death in ICU
|
From the date of admission to ICU until the date of death from any cause during ICU stay, assessed up to 24 months
|
|
Time spent on extracorporeal support
Time Frame: From the date of admission to ICU, assessed up to 24 weeks
|
Days spent on extracorporeal support.
|
From the date of admission to ICU, assessed up to 24 weeks
|
Collaborators and Investigators
Sponsor
Collaborators
Publications and helpful links
General Publications
- Huang Z, Wang SR, Su W, Liu JY. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial. 2010 Dec;14(6):596-602. doi: 10.1111/j.1744-9987.2010.00825.x.
- Opal SM, Fisher CJ Jr, Dhainaut JF, Vincent JL, Brase R, Lowry SF, Sadoff JC, Slotman GJ, Levy H, Balk RA, Shelly MP, Pribble JP, LaBrecque JF, Lookabaugh J, Donovan H, Dubin H, Baughman R, Norman J, DeMaria E, Matzel K, Abraham E, Seneff M. Confirmatory interleukin-1 receptor antagonist trial in severe sepsis: a phase III, randomized, double-blind, placebo-controlled, multicenter trial. The Interleukin-1 Receptor Antagonist Sepsis Investigator Group. Crit Care Med. 1997 Jul;25(7):1115-24. doi: 10.1097/00003246-199707000-00010.
- Granowitz EV, Clark BD, Mancilla J, Dinarello CA. Interleukin-1 receptor antagonist competitively inhibits the binding of interleukin-1 to the type II interleukin-1 receptor. J Biol Chem. 1991 Aug 5;266(22):14147-50.
- Fisher CJ Jr, Dhainaut JF, Opal SM, Pribble JP, Balk RA, Slotman GJ, Iberti TJ, Rackow EC, Shapiro MJ, Greenman RL, et al. Recombinant human interleukin 1 receptor antagonist in the treatment of patients with sepsis syndrome. Results from a randomized, double-blind, placebo-controlled trial. Phase III rhIL-1ra Sepsis Syndrome Study Group. JAMA. 1994 Jun 15;271(23):1836-43.
- REMAP-CAP Investigators; Gordon AC, Mouncey PR, Al-Beidh F, Rowan KM, Nichol AD, Arabi YM, Annane D, Beane A, van Bentum-Puijk W, Berry LR, Bhimani Z, Bonten MJM, Bradbury CA, Brunkhorst FM, Buzgau A, Cheng AC, Detry MA, Duffy EJ, Estcourt LJ, Fitzgerald M, Goossens H, Haniffa R, Higgins AM, Hills TE, Horvat CM, Lamontagne F, Lawler PR, Leavis HL, Linstrum KM, Litton E, Lorenzi E, Marshall JC, Mayr FB, McAuley DF, McGlothlin A, McGuinness SP, McVerry BJ, Montgomery SK, Morpeth SC, Murthy S, Orr K, Parke RL, Parker JC, Patanwala AE, Pettila V, Rademaker E, Santos MS, Saunders CT, Seymour CW, Shankar-Hari M, Sligl WI, Turgeon AF, Turner AM, van de Veerdonk FL, Zarychanski R, Green C, Lewis RJ, Angus DC, McArthur CJ, Berry S, Webb SA, Derde LPG. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. N Engl J Med. 2021 Apr 22;384(16):1491-1502. doi: 10.1056/NEJMoa2100433. Epub 2021 Feb 25.
- Huang Z, Wang SR, Yang ZL, Liu JY. Effect on extrapulmonary sepsis-induced acute lung injury by hemoperfusion with neutral microporous resin column. Ther Apher Dial. 2013 Aug;17(4):454-61. doi: 10.1111/j.1744-9987.2012.01083.x. Epub 2012 Jun 21.
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
- 160716
- 340810 (Other Identifier: IRAS)
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.
Clinical Trials on Inflammation
-
University of EdinburghUmeå UniversityCompletedSystemic Inflammation | Respiratory InflammationSweden
-
University of AarhusAarhus University Hospital; University of CopenhagenCompletedSystemic Inflammation | Airway InflammationDenmark
-
Sykehuset TelemarkRikshospitalet University Hospital; Helse Sor-OstCompletedAirway Inflammation | Peripheral Blood Inflammation Markers | Cement Dust ExposureNorway
-
Center for Research and Innovation Viña Concha...Universidad Católica del MauleNot yet recruitingInflammaging | Antioxidant Status, Inflammation | Inflammation Biomarkers | Antioxidant Capabilities | Cardiometabolic Health IndicatorsChile
-
University of NebraskaNot yet recruiting
-
Ahmad ElheenyActive, not recruiting
-
Assistance Publique - Hôpitaux de ParisCompletedDigestive InflammationFrance
-
Pamukkale UniversityCompletedPeriodontal InflammationTurkey
-
Universidade Federal do ParaCompleted
Clinical Trials on HA 380
-
AVEO Pharmaceuticals, Inc.Recruiting
-
National Cancer Centre, SingaporeSingapore General Hospital; Singhealth Duke-NUS Oncology Academic Clinical...Completed
-
AVEO Pharmaceuticals, Inc.Completed
-
Ospedale Policlinico San MartinoUniversita degli Studi di Genova; IRCSS Istituto Dermopatico dell'Immacolata...CompletedDiabetic Foot Ulcer | PRP | Allogeneic | Skin LesionsItaly
-
Galderma R&DTerminatedFacial Tissue AugmentationSweden
-
Universitätsklinikum Hamburg-EppendorfRecruiting
-
Dana-Farber Cancer InstituteBreast Cancer Research Foundation; Array BioPharmaCompletedAdvanced HER2-positive Breast Cancer | Brain Metastases From HER2 and Breast CancerUnited States
-
Medy-ToxCompletedNasolabial FoldKorea, Republic of
-
TauTona GroupCompleted