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Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery (IABCS)
Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery: a Randomized Controlled Trial
Studie Overzicht
Toestand
Interventie / Behandeling
Gedetailleerde beschrijving
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.
Studietype
Inschrijving (Verwacht)
Fase
- Niet toepasbaar
Contacten en locaties
Studie Locaties
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SP
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Sao Paulo, SP, Brazilië, 05403000
- Werving
- Heart Institute
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Contact:
- Graziela Ferreira, Dr
- Telefoonnummer: 11-26615367
- E-mail: gsrf@uol.com.br
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Contact:
- Ludhmila A Hajjar, PhD
- Telefoonnummer: 11-26615232
- E-mail: ludhmila@usp.br
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Hoofdonderzoeker:
- Ludhmila A Hajjar, PhD
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
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
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
|
Actieve vergelijker: Preoperative intra-aortic balloon pump.
Intervention: Preoperative placement of the intra-aortic balloon pump.
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Preoperative placement of the intra-aortic balloon pump.
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Geen tussenkomst: Control
No preoperative placement of the intra-aortic balloon pump.
|
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Composite 30-day mortality or major morbidity (mechanical ventilation > 24 hours, mediastinitis, surgical reexploration, stroke, cardiogenic shock, acute renal failure)
Tijdsspanne: 30 days
|
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
|
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Duration of mechanical ventilation
Tijdsspanne: 30 days
|
Number of days during mechanical ventilation.
|
30 days
|
|
IABP complications
Tijdsspanne: 30 days
|
Number of patients presenting one of the following: lower limb ischemia, mesenteric ischemia or bleeding.
|
30 days
|
|
Use of vasoactive agents
Tijdsspanne: 30 days
|
Number of days and dose of inotropes and vasopressors.
|
30 days
|
|
Evaluation of hemodynamic data
Tijdsspanne: 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
|
|
Levels of biomarkers
Tijdsspanne: 7 days
|
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
Tijdsspanne: 7 days
|
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
Tijdsspanne: 30 days
|
Death during hospital stay or death after hospital discharge until 30 days following the procedure
|
30 days
|
|
60-days mortality
Tijdsspanne: 60 days
|
Death until 60 days following the procedure
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60 days
|
|
1-year mortality
Tijdsspanne: 1 year
|
Death until 1 year following the procedure
|
1 year
|
|
Costs
Tijdsspanne: 30 days
|
Comparison of overall costs between groups.
|
30 days
|
|
Acute Kidney Injury
Tijdsspanne: 30 days
|
Incidence of acute kidney injury according the Acute Kidney Injury Network (AKIN) classification.
|
30 days
|
|
Cardiovascular complications
Tijdsspanne: 30 days
|
Arrhythmias or myocardial ischemia within 30 days after randomization
|
30 days
|
|
Infectious complications
Tijdsspanne: 30 days
|
New infection or septic shock within 30 days after randomization
|
30 days
|
|
Delirium
Tijdsspanne: 30 days
|
Acute cognitive dysfunction diagnosed with the use of the CAM-ICU scale within 30 days after randomization
|
30 days
|
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Bleeding
Tijdsspanne: 24 hours
|
Blood losses exceeding 100-300 mL per hour following ICU admission
|
24 hours
|
Medewerkers en onderzoekers
Sponsor
Publicaties en nuttige links
Algemene publicaties
- 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.
Studie record data
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Studie start
Primaire voltooiing (Verwacht)
Studie voltooiing (Verwacht)
Studieregistratiedata
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Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
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Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Andere studie-ID-nummers
- Heart Institute
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