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HemorrhageNCT02145858

Prevention of Retained-Blood Outcomes With Active Clearance Technology

An observational study of Hemorrhage and Atrial Fibrillation, Postoperative, run by ClearFlow, Inc. at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Postoperative bleeding is a common consequence after heart surgery which can significantly impact outcomes and costs . When bleeding occurs, reliable postoperative blood evacuation of the pleural, mediastinal and pericardial spaces with chest tubes is imperative to facilitate pulmonary reexpansion and mediastinal… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Blood drainage post cardiac surgery using PleuraFlow System
Type of treatment
Medical device
How many people
891 participants
Where
2 sitesUnited States
Study dates
Jun 2014to 30 Nov 2016
How long will I take part?
1 Month
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Subjects 18 years or older who received a PleuraFlow System following heart surgery

Who may be able to join

  • Male or Female subjects 18 years or older who received a PleuraFlow System following heart surgery.
  • Patient undergoing cardiac surgery via sternotomy.

Who cannot join

  • Any condition deemed inappropriate for inclusion by the investigators.
  • Infants, children and adolescents under the age of 18.
  • Robotic surgery.
  • Any access via thoracotomy.
  • Intolerance to implantable silicone materials.

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Catholic Medical Center

    Manchester, New Hampshire, 03102

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232-8802

Other trials in United States

About this study

Official title: Prevention of Retained-Blood Outcomes With Active Clearance Technology. ACT Registry

Postoperative bleeding is a common consequence after heart surgery which can significantly impact outcomes and costs . When bleeding occurs, reliable postoperative blood evacuation of the pleural, mediastinal and pericardial spaces with chest tubes is imperative to facilitate pulmonary reexpansion and mediastinal decompression as the patient recovers. When postoperative blood evacuation is inadequate, complications from retained blood can result. Clinically, retained blood may be recognized acutely or sub acutely. The acute clinical presentation is usually blood and fresh thrombus around the heart or lungs presenting as tamponade or hemothorax. The subacute clinical presentation is bloody pleural or pericardial effusions. These effusions are often driven by the breakdown of remaining thrombus. Once retained blood occurs, subsequent procedures may be needed to remedy it. Interventions to remove postoperative pericardial and/or pleural fluid or blood and reoperations due to bleeding are captured under a composite termed Retained Blood Syndrome, or RBS. The need for treatment and interventions for these conditions represents an impediment to patient recovery and involves both resource and economic consumption for a heart program and the healthcare system at large.

A recent review of the literature indicates that additional procedures for RBS are demonstrated in approximately 15% to 20% of patients after heart surgery. In a prospectively collected US Nationwide Inpatient Sample (NIS) data from 2010, RBS could be demonstrated in 17% of patients. In this analysis, mortality was doubled from 4% to 8%, length of stay was increased by 5 days, and average costs were 55% higher. Patients with RBS, therefore, represent an increased at-risk population for complications and costs.

Read more

Postoperative obstruction of conventional chest tubes with blood and other fibrinous material in the setting of postoperative bleeding contributes to RBS. In a study of postoperative cardiac surgery patients at the Cleveland Clinic, 36% of patients were found to have evidence of chest tube obstruction. Active Clearance with PleuraFlow has been shown to prevent chest tube clogging, and reduce RBS.

The purpose of this registry is to evaluate the effectiveness of the PleuraFlow System, a commercial Class II (US), Class IIb (Canada, Europe, and Australia), in the management of blood evacuation after cardiac surgery.

Read the detailed description

This is a prospective multicenter observational registry with a retrospective control. The registry has two tracks. One track--ALL-ACT-- is for sites enrolling a consecutive cohort of all cardiac surgery patients (Track A). The second track--VAD-ACT-- is for sites enrolling patients post ventricular assist device (VAD) surgery (Track B). There are two conditions for participation in this registry:

First, sites are required to provide anonymized matched historical data elements from a cohort of cardiac surgery patients done over the preceding 12 to 24-month period (Phase 0). These retrospective data elements will be used as baseline information for the purpose of comparative analyses (control group) with the prospective data sets collected during the prospective enrollment phase (treatment group).

Second, sites are required to participate in a roll-in phase (Phase 1). The purposes of the roll-in phase are to allow the users at participating sites to familiarize themselves with the use of the product with Active Clearance Technology; to implement clinical use protocols provided by ClearFlow, Inc. to all commercial users as part of product training, and; to demonstrate consistency and compliance with the clinical use protocols.

Phase 0 and phase 1 can be executed in parallel. Participating sites may start prospective enrollment (Phase 2) after completion of phase 0 and 1.

Investigators shall report PleuraFlow-related serious injuries to Sponsor as soon as becoming aware of the injury and no later than 48 hours.

Investigators shall report deaths to both the Sponsor and Regulatory authorities in compliance with their applicable State, Country and conditions imposed by the reviewing Ethical Committee. The three main guidance documents for reporting recall and vigilance procedure of medical devices are, 21 CFR, Part 806, MEDDEV 2.12/1 rev8 Guidelines on a Medical Devices Vigilance System, and Health Canada Medical Device Regulations SOR/98-282.

Vanderbilt University will create a REDCap database specific to this study and administer it. The Vanderbilt database study administrator will control database access, oversee data entry and data transfer from each participating site. Database manager will monitor the REDCap database and ensure data completeness and security. The database manager will maintain contact will the data entry personnel from each site and ensure whether data capture is occurring and determine the number of patients expected to be enrolled in the Registry at the end of the study period. Sponsor will not have access to REDCap once the study is complete. The REDCap database is secure and HIPAA compliant.

Descriptive statistics for categorical variables will be reported as percentages, and continuous variables will be reported as mean ± standard deviation (SD). Categorical variables will be compared using the chi-square test. Continuous variables will be compared using a Student's t-test as appropriate.

Database study administrator will coordinate the generation of data reports and statistical outputs. Sponsor will not have access to REDCap once the study is complete.

Being tested
Blood drainage post cardiac surgery using PleuraFlow System
Keywords
atrial fibrillation, pericardial effusion, pleural effusion
Medical subject headings
Hemorrhage, Atrial Fibrillation, Pericardial Effusion, Pleural Effusion

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Blood drainage post cardiac surgery using PleuraFlow SystemDevice

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of Retained Blood Syndrome (RBS)

    The incidence of RBS as defined by a composite endpoint of specific interventions and diagnoses. Any patient that has a record of any of the following interventions or diagnoses post-operatively including post-discharge, will be considered to have RBS.

    • Interventions
    • Reoperation for bleeding, tamponade or washout of retained blood
    • Pericardial window
    • Chest tube placement/replacement
    • Pericardiocentesis
    • Placement of pericardial drain
    • Thoracotomy
    • Thoracoscopy
    • Thoracentesis
    • Diagnoses
    • Pleural effusion
    • Pericardial effusion
    • Hemothorax
    • Pneumothorax
    • Pericardial tamponade

    Measured: surgery to post-operative 30 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 May 2014 (estimated)
  2. Study startJun 2014
  3. Primary completionJul 2016
  4. Study completion30 Nov 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
891 participants (actual)
Target duration
1 Month
IDs, dates and publications
ClinicalTrials.gov ID
NCT02145858
Sponsor's protocol ID
CL2014001
Status last verified
May 2018
First submitted
21 May 2014
Last updated
17 May 2018
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes

Publications

  • Boyle EM Jr, Gillinov AM, Cohn WE, Ley SJ, Fischlein T, Perrault LP. Retained Blood Syndrome After Cardiac Surgery: A New Look at an Old Problem. Innovations (Phila). 2015 Sep-Oct;10(5):296-303. doi: 10.1097/IMI.0000000000000200.

    PubMed 26575376
  • Light RW. Pleural effusions following cardiac injury and coronary artery bypass graft surgery. Semin Respir Crit Care Med. 2001 Dec;22(6):657-64. doi: 10.1055/s-2001-18802.

    PubMed 16088710
  • Light RW. Pleural effusions after coronary artery bypass graft surgery. Curr Opin Pulm Med. 2002 Jul;8(4):308-11. doi: 10.1097/00063198-200207000-00011.

    PubMed 12055394
  • Light RW, Rogers JT, Cheng D, Rodriguez RM. Large pleural effusions occurring after coronary artery bypass grafting. Cardiovascular Surgery Associates, PC. Ann Intern Med. 1999 Jun 1;130(11):891-6. doi: 10.7326/0003-4819-130-11-199906010-00004.

    PubMed 10375337
  • Light RW, Rogers JT, Moyers JP, Lee YC, Rodriguez RM, Alford WC Jr, Ball SK, Burrus GR, Coltharp WH, Glassford DM Jr, Hoff SJ, Lea JW 4th, Nesbitt JC, Petracek MR, Starkey TD, Stoney WS, Tedder M. Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery. Am J Respir Crit Care Med. 2002 Dec 15;166(12 Pt 1):1567-71. doi: 10.1164/rccm.200203-184OC. Epub 2002 Oct 11.

    PubMed 12406850
  • Ikaheimo MJ, Huikuri HV, Airaksinen KE, Korhonen UR, Linnaluoto MK, Tarkka MR, Takkunen JT. Pericardial effusion after cardiac surgery: incidence, relation to the type of surgery, antithrombotic therapy, and early coronary bypass graft patency. Am Heart J. 1988 Jul;116(1 Pt 1):97-102. doi: 10.1016/0002-8703(88)90255-4.

    PubMed 3260740
  • Shalli S, Boyle EM, Saeed D, Fukamachi K, Cohn WE, Gillinov AM. The active tube clearance system: a novel bedside chest-tube clearance device. Innovations (Phila). 2010 Jan;5(1):42-7. doi: 10.1097/IMI.0b013e3181cf7ce3.

    PubMed 22437275
  • Karimov JH, Gillinov AM, Schenck L, Cook M, Kosty Sweeney D, Boyle EM, Fukamachi K. Incidence of chest tube clogging after cardiac surgery: a single-centre prospective observational study. Eur J Cardiothorac Surg. 2013 Dec;44(6):1029-36. doi: 10.1093/ejcts/ezt140. Epub 2013 Mar 21.

    PubMed 23520232
  • Shiose A, Takaseya T, Fumoto H, Arakawa Y, Horai T, Boyle EM, Gillinov AM, Fukamachi K. Improved drainage with active chest tube clearance. Interact Cardiovasc Thorac Surg. 2010 May;10(5):685-8. doi: 10.1510/icvts.2009.229393. Epub 2010 Feb 23.

    PubMed 20179137
  • Arakawa Y, Shiose A, Takaseya T, Fumoto H, Kim HI, Boyle EM, Gillinov AM, Fukamachi K. Superior chest drainage with an active tube clearance system: evaluation of a downsized chest tube. Ann Thorac Surg. 2011 Feb;91(2):580-3. doi: 10.1016/j.athoracsur.2010.10.018.

    PubMed 21256318
  • Perrault LP, Pellerin M, Carrier M, Cartier R, Bouchard D, Demers P, Boyle EM. The PleuraFlow Active Chest Tube Clearance System: initial clinical experience in adult cardiac surgery. Innovations (Phila). 2012 Sep-Oct;7(5):354-8. doi: 10.1097/IMI.0b013e31827e2b4d.

    PubMed 23274869
  • Sirch J, Ledwon M, Puski T, Boyle EM, Pfeiffer S, Fischlein T. Active clearance of chest drainage catheters reduces retained blood. J Thorac Cardiovasc Surg. 2016 Mar;151(3):832-838.e2. doi: 10.1016/j.jtcvs.2015.10.015. Epub 2015 Oct 22.

    PubMed 26611748
  • Baribeau Y, Westbrook B, Baribeau Y, Maltais S, Boyle EM, Perrault LP. Active clearance of chest tubes is associated with reduced postoperative complications and costs after cardiac surgery: a propensity matched analysis. J Cardiothorac Surg. 2019 Nov 8;14(1):192. doi: 10.1186/s13019-019-0999-3.

    PubMed 31703606
  • Maltais S, Davis ME, Haglund NA, Perrault L, Kushwaha SS, Stulak JM, Boyle EM. Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation. ASAIO J. 2016 Nov/Dec;62(6):704-709. doi: 10.1097/MAT.0000000000000437.

    PubMed 27556153

Questions about this trial

What is this clinical trial studying?

An observational study of Hemorrhage and Atrial Fibrillation, Postoperative, run by ClearFlow, Inc. at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 17 May 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of Retained Blood Syndrome (RBS) (time frame: surgery to post-operative 30 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02145858, which also lists 14 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 May 2018.

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