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- Essai clinique NCT02143544
Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery (IABCS)
Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery: a Randomized Controlled Trial
Aperçu de l'étude
Statut
Intervention / Traitement
Description détaillée
High-risk patients undergoing cardiac surgery are at high risk for myocardial ischemia, arrhythmia, cardiogenic shock and other clinical complications. Different therapeutic options are available to support these patients in the perioperative period including inotropes, vasopressors, and vasodilators, and also assist devices such as intra-aortic balloon pump (IABP) and others.
IABP increases myocardial oxygen supply by increasing diastolic coronary perfusion pressure and decreases myocardial oxygen demand by reducing left ventricular afterload. Additionally, IABP can also improve cardiac output and systemic perfusion. The hypothesis of this randomized and controlled trial is that the placement of IABP immediately before the cardiac surgery reduces clinical complications in high-risk patients.
Type d'étude
Inscription (Anticipé)
Phase
- N'est pas applicable
Contacts et emplacements
Coordonnées de l'étude
- Nom: Ludhmila A Hajjar, PhD
- Numéro de téléphone: 11-26625232
- E-mail: ludhmila@usp.br
Sauvegarde des contacts de l'étude
- Nom: Graziela Ferreira, Dr
- Numéro de téléphone: 11-26615367
- E-mail: gsrf@uol.com.br
Lieux d'étude
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SP
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Sao Paulo, SP, Brésil, 05403000
- Recrutement
- Heart Institute
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Contact:
- Graziela Ferreira, Dr
- Numéro de téléphone: 11-26615367
- E-mail: gsrf@uol.com.br
-
Contact:
- Ludhmila A Hajjar, PhD
- Numéro de téléphone: 11-26615232
- E-mail: ludhmila@usp.br
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Chercheur principal:
- Ludhmila A Hajjar, PhD
-
-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Age equal to or higher than 18 years old
- EuroSCORE equal to or higher than 6 or ejection fraction equal to or lower than 40%
- Written informed consent
Exclusion Criteria:
- Cardiogenic shock
- Acute myocardial infarction (AMI) < 48 hours
- Mechanical complications of AMI
- Peripheral vascular disease (aorta, iliac or femoral)
- Severe aortic regurgitation
- Neoplasm
- Pregnancy
- Tachyarrhythmia
- Procedures of the aorta
- Coagulopathy
- Thrombocytopenia
- Cardiac transplantation, congenital heart disease or endocarditis
- Refusal to consent
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
---|---|
Comparateur actif: Preoperative intra-aortic balloon pump.
Intervention: Preoperative placement of the intra-aortic balloon pump.
|
Preoperative placement of the intra-aortic balloon pump.
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Aucune intervention: Control
No preoperative placement of the intra-aortic balloon pump.
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
Composite 30-day mortality or major morbidity (mechanical ventilation > 24 hours, mediastinitis, surgical reexploration, stroke, cardiogenic shock, acute renal failure)
Délai: 30 days
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Composite outcome of 30-day mortality or incidence of patients presenting a major complication according to modified Society of Thoracic Surgeons (STS): mechanical ventilation > 24 hours, deep sternal wound infection/mediastinitis, surgical reexploration, stroke, cardiogenic shock and acute renal failure.
|
30 days
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
Duration of mechanical ventilation
Délai: 30 days
|
Number of days during mechanical ventilation.
|
30 days
|
IABP complications
Délai: 30 days
|
Number of patients presenting one of the following: lower limb ischemia, mesenteric ischemia or bleeding.
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30 days
|
Use of vasoactive agents
Délai: 30 days
|
Number of days and dose of inotropes and vasopressors.
|
30 days
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Evaluation of hemodynamic data
Délai: 48 hours
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Comparison of the following hemodynamic data between groups: heart rate, arterial pressure and cardiac output.
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48 hours
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Levels of biomarkers
Délai: 7 days
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Comparison of the following biomarker levels between groups: pro-BNP (Brain natriuretic peptide), troponin I and Neutrophil gelatinase-associated lipocalin (NGAL), Heart-type Fatty Acid Binding Protein (H-FABP)
|
7 days
|
Echocardiographic parameters
Délai: 7 days
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Comparison of the following echocardiographic parameters between groups: left ventricular ejection fraction, cardiac output, left ventricular diastolic diameter, left ventricular systolic diameter and wall motion abnormalities.
|
7 days
|
30-day mortality
Délai: 30 days
|
Death during hospital stay or death after hospital discharge until 30 days following the procedure
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30 days
|
60-days mortality
Délai: 60 days
|
Death until 60 days following the procedure
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60 days
|
1-year mortality
Délai: 1 year
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Death until 1 year following the procedure
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1 year
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Costs
Délai: 30 days
|
Comparison of overall costs between groups.
|
30 days
|
Acute Kidney Injury
Délai: 30 days
|
Incidence of acute kidney injury according the Acute Kidney Injury Network (AKIN) classification.
|
30 days
|
Cardiovascular complications
Délai: 30 days
|
Arrhythmias or myocardial ischemia within 30 days after randomization
|
30 days
|
Infectious complications
Délai: 30 days
|
New infection or septic shock within 30 days after randomization
|
30 days
|
Delirium
Délai: 30 days
|
Acute cognitive dysfunction diagnosed with the use of the CAM-ICU scale within 30 days after randomization
|
30 days
|
Bleeding
Délai: 24 hours
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Blood losses exceeding 100-300 mL per hour following ICU admission
|
24 hours
|
Collaborateurs et enquêteurs
Parrainer
Publications et liens utiles
Publications générales
- Caldas JR, Panerai RB, Bor-Seng-Shu E, Ferreira GSR, Camara L, Passos RH, Salinet AM, Azevedo DS, de-Lima-Oliveira M, Galas FRBG, Fukushima JT, Nogueira R, Taccone FS, Landoni G, Almeida JP, Robinson TG, Hajjar LA. Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial. Ann Intensive Care. 2019 Nov 27;9(1):130. doi: 10.1186/s13613-019-0602-z.
- Caldas JR, Panerai RB, Bor-Seng-Shu E, Ferreira GSR, Camara L, Passos RH, de-Lima-Oliveira M, Galas FRBG, Almeida JP, Nogueira RC, Mian N, Gaiotto FA, Robinson TG, Hajjar LA. Dynamic cerebral autoregulation: A marker of post-operative delirium? Clin Neurophysiol. 2019 Jan;130(1):101-108. doi: 10.1016/j.clinph.2018.11.008. Epub 2018 Nov 22.
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Anticipé)
Achèvement de l'étude (Anticipé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Autres numéros d'identification d'étude
- Heart Institute
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