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Acute Exacerbation of COPDVENT-AVOIDNCT03255057

Extracorporeal CO2 Removal With the Hemolung RAS for Mechanical Ventilation Avoidance During Acute Exacerbation of COPD

A study testing Hemolung Respiratory Assist System and Invasive mechanical ventilation in people with Acute Exacerbation of COPD, run by Alung Technologies at 32 sites in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This study evaluates the safety and efficacy of using the Hemolung RAS to provide low-flow extracorporeal carbon dioxide removal (ECCO2R) as an alternative or adjunct to invasive mechanical ventilation for patients who require respiratory support due to an acute exacerbation of Chronic Obstructive Pulmonary Disease… Read more about this study

Who is it for?
Ages 40 years and older
Conditions the study is for
Acute Exacerbation of COPD
What is being tested?
Hemolung Respiratory Assist System and Invasive mechanical ventilation
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
113 participants
Where
32 sitesUnited States
Study dates
18 Feb 2018to 17 Aug 2022
Phase
Interventional
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 40 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 40 years
  • Confirmed diagnosis of underlying COPD or ACOS (Asthma-COPD Overlap Syndrome)
  • Experiencing acute hypercapnic respiratory failure
  • Informed consent from patient or legally authorized representative
  • Meets one of the three following criteria:
  • Is at high risk of requiring intubation and invasive mechanical ventilation (MV) after at least one hour on NIV due to one or more of the following:
Show all 17Show fewer
  • Respiratory acidosis (arterial pH <= 7.25) despite NIV
  • Worsening hypercapnia or respiratory acidosis relative to baseline blood gases
  • No improvement in PaCO2 relative to baseline blood gases and presence of moderate or severe dyspnea
  • Presence of tachypnea > 30 breaths per minute
  • Intolerance of NIV with failure to improve or worsening acidosis, dyspnea or work of breathing
  • OR
  • After starting NIV with a baseline arterial pH ≤ 7.25, shows signs of progressive clinical decompensation manifested by decreased mental capacity, inability to tolerate NIV, or increased or decreased respiratory rate in setting of worsened or unchanged acidosis.
  • OR
  • Currently intubated and receiving Invasive MV, meeting both of the following:
  • Intubated for ≤ 5 days (from intubation to time of consent), AND
  • Has failed a spontaneous breathing trial OR is deemed not suitable for a spontaneous breathing trial (SBT) OR is deemed not suitable for extubation

Who cannot join

  • DNR/DNI order
  • Hemodynamic instability (mean arterial pressure < 60 mmHg) despite infusion of vasoactive drugs
  • Acute coronary syndrome
  • Current presence of severe pulmonary edema due to Congestive Heart Failure
  • PaO2/FiO2 < 120 mmHg on PEEP >/= 5 cmH2O
  • Presence of bleeding diathesis or other contraindication to anticoagulation therapy
Show all 21Show fewer
  • Platelet count >= 100,000/mm3 not requiring daily transfusions to maintain platelet count above 100,000/mm3 at time of screening
  • Hemoglobin >= 7.0 gm% not requiring daily transfusions to maintain hemoglobin count above 7.0 gm% at time of screening, and no active major bleeding
  • Unable to protect airway (e.g. unable to generate cough or clear secretions) or significant weakness or paralysis of respiratory muscles due to causes unrelated to acute exacerbation of COPD
  • Cerebrovascular accident, intracranial bleed, head injury or other neurological disorder likely to adversely affect ventilation or airway protection.
  • Hypersensitivity to heparin or history of previous heparin-induced thrombocytopenia (HIT Type II)
  • Presence of a significant pneumothorax or bronchopleural fistula
  • Current uncontrolled, major psychiatric disorder
  • Current participation in any other interventional clinical study
  • Pregnant women (women of child bearing potential require a pregnancy test)
  • Neutropenic (absolute neutrophil count < 1,00mm3, not transient) related to the presence or treatment of a malignancy; recent bone marrow transplant (within prior 8 months); current, uncontrolled AIDS.
  • Fulminant liver failure
  • Known vascular abnormality or condition which could complicate or prevent successful Hemolung Catheter insertion
  • Terminal patients not expected to survive current hospitalization
  • Requiring continuous home ventilation via a tracheostomyy
  • Any disease or condition that, in the judgment of the investigator, either places the subject at undue risk of complications from the Hemolung RAS device, or may reduce the subject's likelihood of benefitting from therapy with the Hemolung RASr

Trial locations and contacts

32 sites in 1 country.

32 sites in 1 country

United States32 sites
  • Albany Medical Center

    Albany, New York, 12208-3412

  • Lehigh Valley Health Network

    Allentown, Pennsylvania, 18103

  • Tufts Medical Center

    Boston, Massachusetts, 02111

  • University of Virginia Medical Center

    Charlottesville, Virginia, 22903

  • UT Erlanger

    Chattanooga, Tennessee, 37403

  • Northwestern Memorial Hospital

    Chicago, Illinois, 60611

  • Cleveland Clinic

    Cleveland, Ohio, 44195

  • Ohio State University

    Columbus, Ohio, 43210

  • Denver Health Medical Center

    Denver, Colorado, 80204

  • Duke University Medical Center

    Durham, North Carolina, 27710

  • Inova Health Care Services

    Falls Church, Virginia, 22042

  • University of Florida - Health Shands

    Gainesville, Florida, 32610

  • Spectrum Health Hospitals

    Grand Rapids, Michigan, 49504

  • UT McGovern Medical School Memorial Hermann

    Houston, Texas, 77030

  • University of Iowa

    Iowa City, Iowa, 52242

  • Mayo Clinic Jacksonville

    Jacksonville, Florida, 32224

  • Lexington VA Healthcare

    Lexington, Kentucky, 40502

  • University of Louisville

    Louisville, Kentucky, 40202

  • WellStar Kennestone Regional Medical Center

    Marietta, Georgia, 30060

  • Memphis VA Medical Center

    Memphis, Tennessee, 38104

  • Minneapolis Heart

    Minneapolis, Minnesota, 55407

  • Rutgers-Robert Wood Johnson University Hospital

    New Brunswick, New Jersey, 08902

  • Northwell Health

    New Hyde Park, New York, 11040

  • New York Presbyterian Hospital/Columbia University Medical Center

    New York, New York, 10032

  • Christiana Care Health System

    Newark, Delaware, 19718

  • Hospital of University of Pennsylvania

    Philadelphia, Pennsylvania, 19104

  • Temple University

    Philadelphia, Pennsylvania, 19140

  • Allegheny General Hospital

    Pittsburgh, Pennsylvania, 15212

  • Rhode Island Hospital

    Providence, Rhode Island, 02903

  • UC Davis Medical Group

    Sacramento, California, 95817

  • LSU Health Shreveport

    Shreveport, Louisiana, 71103

  • Baylor Scott and White Memorial Hospital

    Temple, Texas, 76508

Other trials in United States

About this study

Official title: A Prospective, Multi-Center, Randomized, Controlled, Pivotal Trial to Validate the Safety and Efficacy of the Hemolung® Respiratory Assist System for COPD Patients Experiencing an Acute Exacerbation Requiring Ventilatory Support

This study evaluates the safety and efficacy of using the Hemolung RAS to provide low-flow extracorporeal carbon dioxide removal (ECCO2R) as an alternative or adjunct to invasive mechanical ventilation for patients who require respiratory support due to an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). It is hypothesized that the Hemolung RAS can be safely used to avoid or reduce time on invasive mechanical ventilation compared to COPD patients treated with standard-of-care mechanical ventilation alone. Eligible patients will be randomized to receive lung support with either the Hemolung RAS plus standard-of-care mechanical ventilation, or standard-of-care mechanical ventilation alone.

Read the detailed description

The Hemolung RAS provides low-flow ECCO2R using a single, 15.5 French dual-lumen catheter inserted percutaneously in the femoral or jugular vein. Low-flow ECCO2R offers an alternative or supplement to invasive mechanical ventilation (MV) for patients suffering from acute, reversible, hypercapnic respiratory failure. In contrast to invasive MV, low-flow ECCO2R provides partial ventilatory support independently of the lungs. The rationale for this study is that low-flow ECCO2R with the Hemolung RAS can be used to provide supplemental CO2 removal in COPD patients experiencing acute hypercapnic respiratory failure to either avoid or reduce time on invasive MV. In this patient population, avoidance or reduced time on invasive MV may have significant clinical benefit in reducing the many complications associated with invasive MV. The major complication risks of low-flow ECCO2R are associated with central venous catheterization and the need for anticoagulation during treatment. This study is designed to evaluate the safety and efficacy of Hemolung RAS plus standard-of-care as compared to standard-of-care alone.

Being tested
Hemolung Respiratory Assist System, Invasive mechanical ventilation

What participants receive

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

  • Hemolung Respiratory Assist SystemDevice

    Also called Low-flow extracorporeal carbon dioxide removal, ECCO2R, Hemolung RAS, Hemolung

    Treatment with a medical device called the Hemolung RAS. The Hemolung RAS includes three components: the Hemolung Controller, the Hemolung Cartridge, and the Hemolung Catheter. The intervention is use of the Hemolung RAS to provide partial lung support for acute hypercapnic lung failure by filtering carbon dioxide from venous blood using a central venous catheter through which venous blood is pumped at flows of 350-550 milliliters per minute to and from an external circuit containing a hollow fiber membrane blood gas exchanger (with heparin-coated fibers) integrated with a centrifugal pump.

  • Invasive mechanical ventilationDevice

    Lung support for acute lung failure applied with a mechanical ventilation device that uses positive pressure to mechanically inflate the lungs and facilitate exhalation via an endotracheal tube or tracheotomy.

Study groups in NCT03255057
Study groupRoleWhat they receive
Hemolung plus SOC IMVExperimentalLow-flow ECCO2R with the Hemolung Respiratory Assist System as an alternative or adjunct to standard-of-care (SOC) invasive mechanical ventilation (IMV)
Receives: Device: Hemolung Respiratory Assist System; Device: Invasive mechanical ventilation
SOC IMVActive comparatorStandard-of-care (SOC) invasive mechanical ventilation (IMV) alone
Receives: Device: Invasive mechanical ventilation

What is being measured

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

  1. The amount of time in the first five days following randomization that a patient is free of Invasive MV and alive

    Statistically analyzed as Ventilator-Free Days during the 5 days from randomization (VFD-5)

    Measured: 5 days

Secondary outcomes (11)
  1. Physiologic benefit

    Based on blood gases and concomitant ventilation parameters

    Measured: Time to extubation from first intubation up to 60 days from randomization

  2. Avoidance of intubation

    Incidence of subjects who did not require intubation at any time during their primary hospital admission for the exacerbation for which they were enrolled in the study.

    Measured: Within 60 days from randomization

  3. Ability to communicate by speaking

    Number of days from randomization to end of treatment (end of Invasive MV in Control Arm and end of Hemolung treatment in Investigational Arm) subject is able to communicate by speaking

    Measured: Randomization to end of treatment or 14 days, whichever is sooner

  4. Ability to eat and drink orally

    Number of days from randomization to end of treatment (end of Invasive MV in Control Arm and end of Hemolung treatment in Investigational Arm) subject is able to eat and drink orally

    Measured: Randomization to end of treatment or 14 days, whichever is sooner

  5. ICU Mobility

    Ability of subject to mobilize in bed and out of bed while in Intensive Care as assessed using ICU Mobility Score (IMS)

    Measured: Randomization to end of treatment or 14 days, whichever is sooner

  6. Daily dose of sedatives, analgesics, and paralytics while in ICU

    A qualify of life measure for subjects while in ICU measured by reported concomitant medications while in ICU.

    Measured: From randomization to ICU discharge up to 60 days from randomization

  7. Incidence of new tracheotomies

    Incidence of new tracheotomies

    Measured: Within 60 days from randomization

  8. Adverse events

    All Serious Adverse Events (SAE) from randomization to 60 days and non-serious adverse events from randomization to ICU discharge or 30 days, whichever is sooner (adjudicated by the Clincal Events Committee)

    Measured: Within 60 days from randomization

  9. All-cause in-hospital mortality

    Subject death from any cause while still admitted to hospital for the acute exacerbation for which they were enrolled in the study.

    Measured: Within 60 days from randomization

  10. All-cause (health-related) mortality at 60 days from randomization

    Incidence of health-related deaths at 60 days from randomization, regardless of subject location at time of death.

    Measured: Within 60 days from randomization

  11. Incidence of failed extubations

    Incidence of re-intubation within 48 hours of extubation for original exacerbation

    Measured: Within 60 days from randomization

Timeline

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

  1. First posted21 Aug 2017
  2. Study start18 Feb 2018
  3. Primary completion10 Aug 2022
  4. Study completion17 Aug 2022

Why it stopped: Lack of enrollment post COVID-19 pandemic

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Prospective, multi-center, randomized, controlled, two-arm, open-label, adaptive, two-strata, pivotal trial
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
113 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03255057
Sponsor's protocol ID
HL-CA-5000
Acronym
VENT-AVOID
Status last verified
Oct 2022
First submitted
9 Aug 2017
Last updated
14 Oct 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes

Publications

  • Burki NK, Mani RK, Herth FJF, Schmidt W, Teschler H, Bonin F, Becker H, Randerath WJ, Stieglitz S, Hagmeyer L, Priegnitz C, Pfeifer M, Blaas SH, Putensen C, Theuerkauf N, Quintel M, Moerer O. A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD. Chest. 2013 Mar;143(3):678-686. doi: 10.1378/chest.12-0228.

    PubMed 23460154
  • Duggal A, Conrad SA, Barrett NA, Saad M, Cheema T, Pannu S, Romero RS, Brochard L, Nava S, Ranieri VM, May A, Brodie D, Hill NS; VENT-AVOID Investigators. Extracorporeal Carbon Dioxide Removal to Avoid Invasive Ventilation During Exacerbations of Chronic Obstructive Pulmonary Disease: VENT-AVOID Trial - A Randomized Clinical Trial. Am J Respir Crit Care Med. 2024 Mar 1;209(5):529-542. doi: 10.1164/rccm.202311-2060OC.

    PubMed 38261630
  • Stokes JW, Gannon WD, Rice TW. Extracorporeal Carbon Dioxide Removal or Extracorporeal Membrane Oxygenation: Why Should We Care? Crit Care Med. 2021 May 1;49(5):e546-e547. doi: 10.1097/CCM.0000000000004844. No abstract available.

    PubMed 33854019

Questions about this trial

What is this clinical trial studying?

A study testing Hemolung Respiratory Assist System and Invasive mechanical ventilation in people with Acute Exacerbation of COPD, run by Alung Technologies at 32 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 17 inclusion and 21 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: stopped early, as of the sponsor's last update on 14 Oct 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 32 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 was stopped early (reason given: Lack of enrollment post COVID-19 pandemic). Results are not available in the source record.

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?

The amount of time in the first five days following randomization that a patient is free of Invasive MV and alive (time frame: 5 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 NCT03255057, 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 14 Oct 2022.

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