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POC - Transfusion Algorithm Cardiac Study (TACS)

1. desember 2016 oppdatert av: Jo Carroll, University Health Network, Toronto

Blood Conservation in Cardiac Surgery Using a Novel Transfusion Algorithm Based on Point-of-care Testing-A Stepped-wedge Cluster Randomized Controlled Trial

This multi-centre study will provide sound, generalizable data on the effectiveness of a POC-based algorithm to determine to what extent this guideline can reduce blood product transfusions. Investigators will study outcomes in 7000 patients undergoing heart surgery at 10 participating hospitals. The proposed trial addresses several important research and clinical issues and has the potential to markedly improve the transfusion management and surgical care in general of cardiac surgery patients.

The intervention will be a novel POC-based algorithm that has been shown in a pilot study by us to be associated with a substantial reduction in blood product transfusions. The algorithm will employ viscoelastic and aggregometric POC-tests and an objective measure of blood loss. The primary outcome will be avoidance of red blood cell transfusion during hospitalization. The study has a 90% power to detect a 12% increase in avoidance rate. Secondary outcomes will include avoidance of red blood cell use and other blood products (plasma, platelets, and cryoprecipitate), units of blood products transfused, and adverse clinical outcomes related to transfusion (acute kidney injury, infections, and death). Data will also be collected for future health-economics analyses.

Largely due to the limitations of existing evidence, however, such algorithms are rarely used in clinical practice. The proposed trial will provide sound, generalizable data on the effectiveness of a POC-based algorithm to guide their future use. An integrated blood management algorithm that employs POC coagulation tests will reduce blood product transfusions in cardiac surgery, thereby improving clinical outcomes.

Does an integrated blood transfusion algorithm that employs POC coagulation tests applied across a network of hospitals reduce blood transfusions and associated adverse outcomes in cardiac surgery?

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

Despite major advances in cardiac surgery, coagulopathy continues to carry a heavy burden in cases that require the use of cardiopulmonary bypass (CPB), occurring frequently and resulting in excessive blood loss, blood product transfusions, and adverse clinical outcomes. Current management of coagulopathy is hampered by the inability of conventional laboratory tests to delineate its etiology in a timely manner, thereby precluding timely and targeted transfusion therapy. With the advent of point-of-care (POC) coagulation tests that can rapidly identify the etiology of coagulopathy, it may now be possible to reduce the burden of coagulopathy and thereby reduce transfusions and adverse outcomes. Several single-centre studies (including one by the investigator group) have found that the use of POC-based algorithms in cardiac surgery can markedly reduce blood product transfusions and by that means reduce morbidities and mortality.

Studietype

Intervensjonell

Registrering (Faktiske)

7402

Fase

  • Ikke aktuelt

Kontakter og plasseringer

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

Studiesteder

  • Canada
    • Alberta
      • Calgary, Alberta, Canada, T2N 2T9
        • Dr. Charles McAdams
      • Edmonton, Alberta, Canada
        • Blaine Achen
    • British Columbia
      • Vancouver, British Columbia, Canada, V5Z 1M9
        • Dr. Terry Waters
      • Vancouver, British Columbia, Canada
        • Dr. Sukhpal Brar
    • Manitoba
      • Winnipeg, Manitoba, Canada, R2H 2A6
        • Dr. H. Grocott
    • Ontario
      • Hamilton, Ontario, Canada, L8N 3Z5
        • Dr. Summer Syed
      • London, Ontario, Canada, N6A 5A5
        • Dr. Christopher Harle
      • Newmarket, Ontario, Canada, L3Y 2P9
        • Dr. Daniel Kim
      • Ottawa, Ontario, Canada, K1Y 4W7
        • Dr. D. Tran
      • Toronto, Ontario, Canada, M4N 3M5
        • Dr. F. Moussa
    • Quebec
      • Fleurimont, Quebec, Canada, J1H 5N4
        • Dr. E. Medicis
      • Sainte -Foy, Quebec, Canada, G1V 4G5
        • Dr. J. Bussieres

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

Hospital Inclusion:

  • Participating hospitals must not currently be using a POC-based blood conservation algorithm; must have an in-hospital RBC transfusion rate of > 35% and platelet or plasma transfusion rates of > 20%; must conduct > 600 cardiac surgeries employing CPB per year; and must have commitments from departments of Anesthesia, Cardiac Surgery, and Laboratory Medicine to support the study and to abide by the algorithm
  • Blood transfusion algorithm instituted as standard-of-care at participating hospitals
  • All adult (≥ 18 years) patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) will be included in the analysis.

Exclusion Criteria: Hospitals not meeting inclusion.

Studieplan

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

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Diagnostisk
  • Tildeling: N/A
  • Intervensjonsmodell: Enkeltgruppeoppdrag
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Annen: Transfusion Algorithm
Hospitals will be randomized to the intervention arm of the study in a stratified manner.
Annen: POC-based transfusion algorithm
A transfusion algorithm based on point-of-care coagulation testing.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Point Of Care (POC) Transfusion Algorithm Cardiac Study
Tidsramme: 2.5 years
The primary outcome measure will be the proportion of patients who receive any allogeneic red blood cell (RBC) transfusion from admission before surgery to end of follow-up.
2.5 years

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Transfusion
Tidsramme: 7 days
Allogeneic blood products (platelets, plasma, cryoprecipitate) or coagulation factors (e.g., fibrinogen concentrate, factor VIIa), or undergo re-exploration; units of blood products transfused, nadir hemoglobin concentration (to identify changes in transfusion practice that may be unrelated to treatment of coagulopathy)
7 days
Blood loss
Tidsramme: 24 hours
Chest-tube drainage at 6 and 24 hours after surgery
24 hours
Ventilation and hospital stay
Tidsramme: 24 hours to 7 days
Duration of mechanical ventilation and length of stay in the ICU and hospital
24 hours to 7 days
Kidney injury
Tidsramme: 48 hours
Incidence of acute kidney injury, defined as a ≥ 2-fold in increase in creatinine or new renal replacement therapy within 48 hours after surgery
48 hours
Post operative complications
Tidsramme: 7 days
Arrhythmias, sternal infection, myocardial infarction, stroke, thromboembolic events, and death
7 days

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

University Health Network, Toronto

Publikasjoner og nyttige lenker

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Generelle publikasjoner

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

1. oktober 2014

Primær fullføring (Faktiske)

1. september 2016

Studiet fullført (Faktiske)

1. september 2016

Datoer for studieregistrering

Først innsendt

20. juni 2014

Først innsendt som oppfylte QC-kriteriene

24. juli 2014

Først lagt ut (Anslag)

25. juli 2014

Oppdateringer av studieposter

Sist oppdatering lagt ut (Anslag)

5. desember 2016

Siste oppdatering sendt inn som oppfylte QC-kriteriene

1. desember 2016

Sist bekreftet

1. desember 2016

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • 14-7495-A

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