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C.Surgical Procedure; CardiacPhase 4ALBICSNCT02560519

Albumin in Cardiac Surgery

A Phase 4 study testing Albumin solution and Ringers acetate solution in people with C.Surgical Procedure; Cardiac, run by Helsinki University Central Hospital at 1 site in Finland.

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

Colloid solutions are widely used for volume replacement therapy because of their high oncotic pressure, which could reduce interstitial fluid shifting. Human albumin is the only colloid solution of biologic origin with a molecular weight of 60 kDa. Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
C.Surgical Procedure; Cardiac
What is being tested?
Albumin solution and Ringers acetate solution
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,386 participants
Where
1 siteFinland
Study dates
21 Mar 2017to 4 Nov 2020
Phase
Phase 4
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 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • following primary or repeat open heart surgery procedures, either independently or in combinations:CABG,aortic valve replacement/repair, mitral valve replacement/repair,tricuspid valve replacement/repair,the MAZE procedure or its modifications,surgery on the aortic root or ascending aorta not requiring hypothermic circulatory arrest;
  • scheduled for elective surgery or operated during the index admission

Who cannot join

  • immediate emergency surgery (i.e. no time for recruitment)
  • end-stage kidney disease (estimated GFR<20 mL/min - based on serum/ plasma creatinine)
  • hemophilia A, hemophilia B
  • patient denial of the use of blood products and derivatives of blood products
  • ticagrelor, prasugrel, clopidogrel,apixaban or rivaroxaban treatment within 2 days preoperatively or that of dabigatran within 3 days
  • correction of a congenital heart defect
Show all 9Show fewer
  • preoperative infection compromising post-procedural rehabilitation
  • preoperative heart failure / low output syndrome (preoperative inotropic support, intra-aortic balloon pump, preoperative EF(ejection fraction) < 20 %)
  • preoperative dependency of mechanical ventilation, preoperative ECMO(extra-corporeal membrane oxygenation),left ventrical mechanical assistance.

Trial locations and contacts

1 site in 1 country.

Finland1 site
  • Helsinki University Central Hospital, Meilahti Hospital

    Helsinki, Uusimaa, 00029

Other trials in Finland

About this study

Official title: Albumin vs Ringer Solution for Cardiac Surgery

Colloid solutions are widely used for volume replacement therapy because of their high oncotic pressure, which could reduce interstitial fluid shifting. Human albumin is the only colloid solution of biologic origin with a molecular weight of 60 kDa. As the most abundant plasma protein, it has physiological importance in the well-being of the endothelial glycocalyx. Older studies in septic patients, however, did not show any benefit of albumin over saline solution. Crystalloid solutions, such as Ringer's acetate, do not impair neither renal function nor coagulation, but their volume expanding effect is questionable.

For several reasons (use of heart-lung machine, systemic inflammation, coagulation disturbances), patients undergoing cardiac surgery need especially large amounts of fluids. However, there are no large trials comparing albumin solutions to crystalloid solutions cardiac surgery.

Read more

This double-blinded trial will randomize according to a power analysis 1250 cardiac surgery patients (=625+625) at Meilahti hospital to use either 4% Albumin or Ringer's acetate solutions for both priming of the heart-lung machine and perioperative volume replacement therapy. The primary efficacy and safety endpoint of this study is the incidence of major adverse events (MAE), defined as a composite endpoint of all-cause mortality, acute myocardial infarction, acute heart failure or low output syndrome, resternotomy, stroke, certain arrhythmias, major bleeding, infections compromising post-procedural rehabilitation, acute kidney injury within 90 days postoperatively. The secondary outcomes are total number of MAEs, major adverse cardiac events (MACE), perioperative fluid balance, blood product transfusions, blood loss, acute kidney injury, days alive without mechanical ventilation/outside ICU/at home in 90 days as well as 90-day mortality. Blood samples for biochemical analyses will be collected at four perioperative time points.

This trial will provide data about efficacy and safety of 4% albumin in cardiac surgery patients. The biochemical mechanisms of albumin will be assessed.

Read the detailed description

The use of cardiopulmonary bypass (CPB) between two study solutions: albumin solution with the final concentration of 4% and Ringer's acetate solution. The trial consists of two phases as follows. For each patient, one and the same study solution will used in both phases of the trial according to randomization.

In the first phase of the trial, the study solution will be used for priming of the CPB tubing. The CPB priming volume comprises only of the study solution. See the Blinding section below for more details.

  • Albumin group (trial group): A mixture of 20% (200 mg/mL) albumin solution (Albuman® 200 g/L, Sanquin, the Netherlands) with Ringer's acetate solution (see below) in the final albumin concentration of 4%.
  • Ringer group (conventional group): Ringer's acetate solution (Ringer-acetate®, Baxter; pH 6.0, contents Na+ 131 mmol/L, Cl- 112 mmol/L, acetate 30 mmol/L) alone.

In the second phase of the trial, during surgery and the first 24 hours of ICU treatment, study solution will be used up to 3200 mL for volume replacement therapy. Ringer's acetate solution is used thereafter, i.e. if more than 3200 mL are needed for volume replacement therapy during the second study phase. The volume replacement therapy is not protocolled but will be based on the clinical decision.

Albumin group (trial group):4% (40 mg/mL) albumin(Albuman®, Sanquin, the Netherlands)

•Ringer group (conventional group): Ringer's acetate solution (Ringer-acetate®, Baxter; pH 6.0, contents Na+ 131 mmol/L, Cl- 112 mmol/L, acetate 30 mmol/L) The trial will end after the first 24 hours of ICU treatment or when the patient leaves the ICU if the latter occurs within the first postoperative 24 hours. After the study period, fluids are administered according to the local clinical practice.

The use of blood products, excluding albumin, is not protocolled, but will be based on the clinical decision.

For physiological basic need of fluid, Ringer's acetate solution will be given throughout the study period, i.e. during surgery and postoperatively, as a background infusion of 0.5 ml/kg/h, rounded to the nearest multible of 10 ml.

Being tested
Albumin solution, Ringers acetate solution
Keywords
human serum albumin solution, Cardiopulmonary Bypass

What participants receive

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

  • Albumin solutionDrug

    Also called Albumin

    Albumin solution will used for priming of the CPB(cardio-pulmonary bypass) tubing. : A mixture of 20% (200 mg/mL) albumin (Albuman® 200 g/L, Sanquin, the Netherlands) with Ringer's acetate solution in the final albumin concentration of 4%.

    During surgery and the first 24 hours of ICU treatment, albumin 4% solution will be used up to 3200 mL for volume replacement therapy. Ringer's acetate solution is used thereafter, i.e. if more than 3200 mL are needed for volume replacement therapy.The volume replacement therapy is not determined but will be based on the clinical decision.

  • Ringers acetate solutionDrug

    The Ringers acetate solution will be used for priming of the CPB tubing. The CPB priming volume comprises only of Ringer´s solution.

    During surgery and the first 24 hours of ICU treatment,Ringer´s acetate solution will be used up to 3200 mL for volume replacement therapy. Ringer's acetate solution is used thereafter, i.e. if more than 3200 mL are needed for volume replacement therapy during the second study phase. The volume replacement therapy is not determined but will be based on the clinical decision.

Study groups in NCT02560519
Study groupRoleWhat they receive
Ringers acetate solutionActive comparatorRinger-Acetat Baxter Viaflo® (Baxter Finland, Finland): Ringer-Acetat is iso-oncotic solution.Pharmacodynamic and pharmacokinetic properties: The osmotic effect is approximately the same as that of blood plasma. Electrolytes are given to receive or to keep normal osmotic conditions in the extracellular as well as the intracellular compartment. Acetate is oxidized into bicarbonate, mainly in the muscles and peripheral tissues and gives a weak alkalizing effect. Qualitative and quantitative list of composition: 1000 ml of Ringer-Acetat Baxter Viaflo contains 5.86 g sodium chloride, 0.30 g potassium chloride dihydrate, 0.29 g, 0.20 g magnesium chloride hexahydrate, 4.08 g sodium acetate trihydrate. List of excipients: Water for injections, Hydrochloric acid.
Receives: Drug: Ringers acetate solution
Albumin solutionExperimentalAlbuman® 200g/L (Sanquin, the Netherlands) is a solution containing 200 g/l (20%) of total protein of which at least 95% is human albumin.The solution contains 100 mmol/l of sodium (2.3 g/L). Pharmacodynamic properties: Albumin stabilises circulating blood volume and is a carrier of hormones, enzymes, medicinal products and toxins. Pharmacokinetic properties. Under normal conditions, the average half-life of albumin is about 19 days. Albuman® 40g/L is a solution containing 40 g/l (4%) of total protein of which at least 95% is human albumin. The solution contains 140 mmol/l of sodium (3.2 g/L).
Receives: Drug: Albumin solution

What is being measured

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

  1. Major adverse events

    The number of patients with at least one major adverse event during 90 days postoperatively:all-cause death;acute myocardial injury (increase in CK-MB at least 10 times as high as the upper normal limit);new onset of acute heart failure/low output syndrome requiring intravenous inotropic agents,intra-aortic balloon pump support and/or ECMO,resternotomy/subxiphoidal pericardial drainage;stroke;major arrhythmia (ventricular fibrillation off-CPB,ventricular tachycardia off-CPB,new onset atrial fibrillation of permanent nature requiring anticoagulation, permanent pacing dependency of new onset);major bleeding (chest tube blood loss at 18 hours over 20 mL/kg) or requiring 5 or more units of red blood cell transfusion or an equivalent volume of washed red blood cells within intervention time;infection compromising post-procedural rehabilitation;acute kidney injury(postoperative increase of creatinine at least 2 times compared to the preoperative level),renal replacement therapy

    Measured: 90 days

Timeline

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

  1. First posted25 Sep 2015 (estimated)
  2. Study start21 Mar 2017
  3. Primary completion13 Apr 2020
  4. Study completion4 Nov 2020

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
1,386 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02560519
Sponsor's protocol ID
EPA1
Acronym
ALBICS
Status last verified
Nov 2020
First submitted
24 Sep 2015
Last updated
16 Nov 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Vlasov H, Wilkman E, Petaja L, Suojaranta R, Hiippala S, Tolonen H, Jormalainen M, Raivio P, Juvonen T, Pesonen E. Comparison of 4% Albumin and Ringer's Acetate on Hemodynamics in On-pump Cardiac Surgery: An Exploratory Analysis of a Randomized Clinical Trial. J Cardiothorac Vasc Anesth. 2024 Oct;38(10):2269-2277. doi: 10.1053/j.jvca.2024.07.025. Epub 2024 Jul 20.

    PubMed 39098542
  • Pesonen E, Vlasov H, Suojaranta R, Hiippala S, Schramko A, Wilkman E, Eranen T, Arvonen K, Mazanikov M, Salminen US, Meinberg M, Vahasilta T, Petaja L, Raivio P, Juvonen T, Pettila V. Effect of 4% Albumin Solution vs Ringer Acetate on Major Adverse Events in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Clinical Trial. JAMA. 2022 Jul 19;328(3):251-258. doi: 10.1001/jama.2022.10461.

    PubMed 35852528
  • Vlasov H, Juvonen T, Hiippala S, Suojaranta R, Peltonen M, Schramko A, Arvonen K, Salminen US, Kleine Budde I, Eranen T, Mazanikov M, Meinberg M, Vahasilta T, Wilkman E, Pettila V, Pesonen E. Effect and safety of 4% albumin in the treatment of cardiac surgery patients: study protocol for the randomized, double-blind, clinical ALBICS (ALBumin In Cardiac Surgery) trial. Trials. 2020 Feb 28;21(1):235. doi: 10.1186/s13063-020-4160-3.

    PubMed 32111230

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Albumin solution and Ringers acetate solution in people with C.Surgical Procedure; Cardiac, run by Helsinki University Central Hospital at 1 site in Finland.

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 9 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 16 Nov 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Finland. 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.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

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?

Major adverse events (time frame: 90 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 NCT02560519, which also lists 3 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 16 Nov 2020.

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