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Optimized Cardiopulmonary Bypass Flow Strategy Based on Ideal Body Weight in Obese Patients Undergoing Cardiac Surgery (IDEALFLOW)

29. oktober 2026 oppdatert av: Centre Hospitalier Universitaire, Amiens

Cardiopulmonary bypass (CPB) pump flow is typically calculated according to body surface area (BSA) derived from actual body weight and temperature, following the 2024 European guidelines recommending an indexed flow of 2.4 L/min/m². However, in obese patients, using actual weight leads to a high BSA and thus elevated pump flow, increasing technical challenges such as the need for larger cannulas, higher circulating blood volume, and elevated pump speeds. These adjustments may increase risks of hemodilution, transfusion, and hemolysis. Given that lean body mass in obese patients is similar to that of non-obese patients of the same height-and that aerobic metabolism depends on lean mass-adjusting CPB flow based on ideal body weight rather than actual weight could reduce transfusions and associated complications. Several observational studies support the concept of using ideal body weight for CPB flow calculation in obese patients. Despite this, no randomized controlled trial has yet addressed the clinical impact of this approach. Given the increasing prevalence of obesity and the practical challenges it poses during cardiac surgery, a controlled clinical trial is warranted.

The investigators hypothesize that adjusting the cardiopulmonary bypass (CPB) flow according to the ideal body weight rather than the actual body weight in obese patients could reduce the need for blood transfusions and limit the associated complications.

Studieoversikt

Status

Rekruttering

Forhold

Intervensjon / Behandling

Studietype

Intervensjonell

Registrering (Antatt)

184

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiekontakt

Studiesteder

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

Inclusion Criteria:

  • Patients aged over 18 years
  • Patients with obesity (BMI > 30 kg/m²)
  • Scheduled cardiac surgery under cardiopulmonary bypass (CPB):
  • Coronary artery bypass grafting (CABG)
  • Aortic valve replacement
  • Mitral valve repair or replacement
  • Surgery on the aortic root (aortic tube, Bentall procedure, Tirone David, or others)
  • Combined surgery
  • Affiliation to a social security scheme
  • Written informed consent

Exclusion Criteria:

  • Minors
  • BMI < 30 kg/m²
  • Off-pump cardiac surgery
  • Surgery on the aortic arch
  • Planned perioperative hypothermia < 32ºC
  • Emergency surgery
  • Heart transplantation or mechanical circulatory support surgery
  • Infectious endocarditis
  • Participation in another clinical trial within the past 30 days
  • Pregnant, parturient, or breastfeeding women
  • Patients under guardianship, curatorship, or deprived of civil rights
  • Advanced chronic kidney disease (renal clearance < 30 ml/min)
  • Coexisting disease with a high probability of death within 6 months
  • Preoperative anemia (hemoglobin < 10 g/dL)
  • Body surface area (actual body weight) > 2.5 m²

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Annen
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Enkelt

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Eksperimentell: body surface area (BSA) calculated from ideal body weight

Cardiac surgery under cardiopulmonary bypass (CPB) with CPB flow indexed at 2.4 ml/min/m², using body surface area (BSA) calculated from ideal body weight (Lorentz formula)

CPB is standardized according to the following protocol:

  • Cardiac index at 2.4 ml/min/m²
  • Mean arterial pressure during CPB between 50 and 80 mm Hg
  • Central venous oxygen saturation > 65%
  • Hematocrit > 25%
  • DO₂ > 280 ml/min/m²
  • VCO₂/DO₂ > 6 (VCO₂: CO₂ production) CPB will be performed under normothermia, with a temperature > 36°C.

Anticoagulation will be managed according to center practices to maintain an activated clotting time (ACT) > 400 seconds, in accordance with recommendations.

Aktiv komparator: BSA calculated from actual body weight.

Cardiac surgery under CPB with CPB flow indexed at 2.4 ml/min/m², using BSA calculated from actual body weight.

CPB is standardized according to the following protocol:

  • Cardiac index at 2.4 ml/min/m²
  • Mean arterial pressure during CPB between 50 and 80 mm Hg
  • Central venous oxygen saturation > 65%
  • Hematocrit > 25%
  • DO₂ > 280 ml/min/m²
  • VCO₂/DO₂ > 6 (VCO₂: CO₂ production) CPB will be performed under normothermia, with a temperature > 36°C.

Anticoagulation will be managed according to center practices to maintain an activated clotting time (ACT) > 400 seconds, in accordance with recommendations.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
reduction in the incidence of erythrocyte concentrates transfused
Tidsramme: 1 day

reduction in the incidence of erythrocyte concentrates transfused from the start to the end of cardiopulmonary bypass (CPB)

1 day

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
hematocrit measurement during CPB
Tidsramme: 1 day

Hemodilution quantified by hematocrit measurement during CPB

1 day
Number of platelet concentrates administered during CPB
Tidsramme: 1 day

Number of platelet concentrates administered during CPB

1 day
Number of fresh frozen plasma units administered during CPB
Tidsramme: 1 day

Number of fresh frozen plasma units administered during CPB

1 day
Number of labile blood products administered during the entire ICU stay
Tidsramme: 1 day

Number of labile blood products administered during the entire ICU stay

1 day
Number of Acute kidney injury
Tidsramme: within 7 days

Acute kidney injury defined according to KDIGO criteria by an increase in serum creatinine ≥26.5 μmol/L or at least 1.5 times the baseline value within 7 days after surgery compared to the preoperative baseline

within 7 days

Samarbeidspartnere og etterforskere

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Sponsor

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

21. september 2026

Primær fullføring (Antatt)

1. september 2029

Studiet fullført (Antatt)

1. september 2029

Datoer for studieregistrering

Først innsendt

29. oktober 2026

Først innsendt som oppfylte QC-kriteriene

29. oktober 2026

Først lagt ut (Faktiske)

4. november 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

4. november 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

29. oktober 2026

Sist bekreftet

1. oktober 2026

Mer informasjon

Begreper knyttet til denne studien

Andre studie-ID-numre

  • PI2026_843_0111

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

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