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Acute Heart FailurePC-ECMONCT03508505

Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

An observational study of Acute Heart Failure and Low Output Heart Failure, run by Turku University Hospital at 1 site in Finland.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Cardiac surgery can be not infrequently complicated by cardiac low-output syndrome due to critical preoperative conditions such as cardiogenic shock, poor left ventricular function and severe myocardial ischemia. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Venoarterial extracorporeal oxygenation
Type of treatment
Medical device
How many people
1,000 participants
Where
1 siteFinland
Study dates
1 Jan 2018to 31 Dec 2020
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
  • Adult, Older adult

Study population: Patients who required VA-ECMO for acute heart failure occurring during the index hopsitalization for elective, urgent or emergency adult cardiac surgery such as coronary surgery, heart valve surgery and/or aortic root surgery.

Who may be able to join

  • Patients who required VA-ECMO after elective, urgent or emergency adult cardiac surgery such as coronary surgery, heart valve surgery and/or aortic root surgery.

Who cannot join

  • Any VA-ECMO implanted before index surgical procedure;
  • Patients who underwent postoperatively veno-venous ECMO;
  • Patients who required VA-ECMO after heart transplantation;
  • Patients who required VA-ECMO after any left ventricular assist device.

Trial locations and contacts

1 site in 1 country.

Finland1 site
  • Heart Center, Turku University Hospital

    Turku, 20521

Other trials in Finland

About this study

Cardiac surgery can be not infrequently complicated by cardiac low-output syndrome due to critical preoperative conditions such as cardiogenic shock, poor left ventricular function and severe myocardial ischemia. Suboptimal myocardial protection, technical errors at graft anastomoses or of prosthesis implantation, and hibernating myocardium may further contribute to cardiac low-output syndrome occurring immediately or shortly after cardiac surgery. In this setting, veno-arterial extracorporeal oxygenation (VA-ECMO) is the only means to provide cardiopulmonary support to recovery or as bridge to transplantation.

Data on the real benefit of VA-ECMO after cardiac surgery is limited and often derived from heterogeneous patient populations, which prevent conclusive results on the benefits of VA-ECMO in this setting. This issue will be investigated in the present retrospective European multicenter study.

Read more

In this setting, veno-arterial extracorporeal oxygenation (VA-ECMO) is the only means to provide cardiopulmonary support to recovery or as bridge to transplantation.

Data on the real benefit of VA-ECMO after cardiac surgery is limited and often derived from heterogeneous populations of patients who underwent different cardiac procedures. Patients with cardiac low-output after surgery for aortic dissection or valve surgery are expected to have different baseline characteristics (such as age and comorbidities) and underlying cardiac disease than patients undergoing isolated coronary surgery. Furthermore, available studies included patients operated two decades ago and this does not provide an exact measure of the benefits of this treatment strategy.

The possible benefits of using VA-ECMO after adult cardiac surgery will be investigated in this retrospective European multicenter study.

Read the detailed description

Cardiac surgery can be not infrequently complicated by cardiac low-output syndrome due to critical preoperative conditions such as cardiogenic shock, poor left ventricular function and severe myocardial ischemia. Prolonged aortic cross-clamping, ischemia-reperfusion injury, suboptimal myocardial protection, technical errors at graft anastomoses or of prosthesis implantation, and hibernating myocardium may further contribute to cardiac low-output syndrome occurring immediately or shortly after cardiac surgery. In this setting, veno-arterial extracorporeal oxygenation (VA-ECMO) is the only means to provide cardiopulmonary support to recovery or as bridge to transplantation.

Data on the real benefit of VA-ECMO after cardiac surgery is limited and often derived from heterogeneous and small size series of patients who underwent different cardiac surgery procedures. Patients with cardiac low-output after surgery for aortic dissection or valve surgery are expected to have different baseline characteristics (such as age and comorbidities) and underlying cardiac disease than patients undergoing isolated coronary surgery. Furthermore, available studies included patients operated two decades ago and, in view of the development of perfusion technology and perioperative care, this does not provide an exact measure of the current benefits of this treatment strategy. Importantly, the role of intra-aortic balloon pump, left ventricular venting, duration of VA-ECMO and hospital experience should be evaluated. The investigators sought to investigate these issues in a large multicenter study.

Patients and methods Patients who were treated with VA-ECMO for cardiac low-output after adult cardiac surgery (other than heart transplantation and/or implantation of a left ventricular assist device) in 21 centers of cardiac surgery from January 2010 to December 2017.

Eligibility criteria

  • Patients aged > 18 years;
  • Patients who required VA-ECMO after elective, urgent or emergency adult cardiac surgery such as coronary surgery, heart valve surgery and/or aortic root surgery because of postoperative low-cardiac output syndrome and/or acute respiratory failure.

Exclusion criteria

  • Patients aged < 18 years;
  • Any VA-ECMO implanted before index surgical procedure;
  • Patients who underwent postoperatively veno-venous ECMO;
  • Patients who required VA-ECMO after heart transplantation;
  • Patients who required VA-ECMO after any left ventricular assist device.

Definition criteria Definition criteria and units of measurements are reported beside each baseline, operative and postoperative variables in the electronic datasheet.

Outcomes

  1. Hospital death
  2. Late death
  3. Stroke
  4. Tracheostomy
  5. Gastrointestinal complications
  6. Deep sternal wound infection
  7. Vascular access site infection
  8. Blood stream infection
  9. Peripheral vascular injury
  10. Major lower limb amputation
  11. New onset dialysis
  12. Peak postoperative serum creatinine level
  13. Nadir postoperative pH during VA-ECMO
  14. Peak postoperative arterial lactate level
  15. Nadir postoperative hemoglobin level
  16. Chest drainage output 24 h after surgery
  17. Number of red blood cells units transfused intra- and postoperatively
  18. Reoperation for intrathoracic bleeding
  19. Reoperation for peripheral cannulation-related bleeding
  20. Intensive care unit length of stay
  21. Death on VA-ECMO

Analysis of clinical results

The aim of this registry is to perform a number of analysis evaluating:

  1. Early and late survival of postcardiotomy VA-ECMO;
  2. Predictors and causes of in-hospital death after successful weaning from postcardiotomy VA-ECMO;
  3. Comparative analysis of peripheral versus central postcardiotomy VA-ECMO;
  4. VA-ECMO plus intra-aortic baloon pump vs. isolated VA-ECMO;
  5. Determinants of outcome after prolonged postcardiotomy VA-ECMO (>5 days).

Publication of results The results of these studies will be submitted for publication to international, peer-reviewed journals in the fields of critical care, cardiology or cardiac surgery.

Being tested
Venoarterial extracorporeal oxygenation
Keywords
Acute Heart Failure, Low Output Heart Failure, Cardiac Low Output, Extracorporeal Membrane Oxygenation, ECMO, Venoarterial Extracorporeal membrane oxygenation, Cardiac Surgery
Medical subject headings
Cardiac Output, Low

What participants receive

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

  • Venoarterial extracorporeal oxygenationDevice

    Also called Cardiac surgery, Coronary artery bypass grafting, Aortic valve replacement, Mitral valve repair

    Veno-arterial extracorporeal oxygenation (VA-ECMO) is inserted in the acute setting in case of cardiac low output after adult cardiac surgery in order to provide cardiopulmonary support to recovery or as bridge to transplantation.

What is being measured

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

  1. Hospital death

    All-cause death

    Measured: Up to 30 days after the index cardiac surgery

Secondary outcomes (20)
  1. Late death

    All-cause death

    Measured: Up to 7-year follow-up after the index cardiac surgery

  2. Stroke

    Ischemic infarction or hemorrhagic injury of the brain

    Measured: Up to 30 days after the index cardiac surgery

  3. Tracheostomy

    Respiratory failure requiring tracheostomy

    Measured: Up to 30 days after the index cardiac surgery

  4. Gastrointestinal complications

    Gastrointestinal complications requiring surgical treatment

    Measured: Up to 30 days after the index cardiac surgery

  5. Deep sternal wound infection

    Deep sternal wound infection or mediastinitis

    Measured: Up to 30 days after the index cardiac surgery

  6. Vascular access site infection

    Infection secondary to any vascular access

    Measured: Up to 30 days after the index cardiac surgery

  7. Blood stream infection

    Blood stream infection detected at blood cultures

    Measured: Up to 30 days after the index cardiac surgery

  8. Peripheral vascular injury

    Any aortic and/or peripheral artery complications related to VA-ECMO

    Measured: Up to 30 days after the index cardiac surgery

  9. Major lower limb amputation

    Major lower limb amputation

    Measured: Up to 30 days after the index cardiac surgery

  10. New onset dialysis

    New onset dialysis

    Measured: Up to 30 days after the index cardiac surgery

  11. Peak postoperative serum creatinine level

    Peak postoperative serum creatinine level

    Measured: Up to 30 days after the index cardiac surgery

  12. Nadir postoperative pH during VA-ECMO

    Nadir postoperative pH during VA-ECMO

    Measured: Up to 30 days after the index cardiac surgery

  13. Peak postoperative arterial lactate level

    Peak postoperative arterial lactate level

    Measured: Up to 30 days after the index cardiac surgery

  14. Nadir postoperative hemoglobin level

    Nadir postoperative hemoglobin level

    Measured: Up to 30 days after the index cardiac surgery

  15. Chest drainage output 24 h after surgery

    Chest drainage output 24 h after surgery

    Measured: Up to 24 hours after the index cardiac surgery

  16. Number of red blood cells units transfused intra- and postoperatively

    Number of red blood cells units transfused intra- and postoperatively

    Measured: Up to 30 days after the index cardiac surgery

  17. Reoperation for intrathoracic bleeding

    Reoperation for intrathoracic bleeding

    Measured: Up to 30 days after the index cardiac surgery

  18. Reoperation for peripheral cannulation-related bleeding

    Reoperation for peripheral cannulation-related bleeding

    Measured: Up to 30 days after the index cardiac surgery

  19. Intensive care unit length of stay

    Intensive care unit length of stay

    Measured: Up to 30 days after the index cardiac surgery

  20. Death on VA-ECMO

    Death on VA-ECMO

    Measured: Up to 30 days after the index cardiac surgery

Timeline

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

  1. First posted25 Apr 2018
  2. Study start1 Jan 2018
  3. Primary completion30 Jun 2020 (estimated)
  4. Study completion31 Dec 2020 (estimated)

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
Retrospective
Enrolment
1,000 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03508505
Sponsor's protocol ID
T3/2018
Acronym
PC-ECMO
Status last verified
Mar 2020
First submitted
6 Mar 2018
Last updated
11 Mar 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Upon request, the investigators will ask the Ethical Committee of the participating centers for permission to share all individual participant data included in this registry with the exception of data through which the patients could be identified.

Publications

  • Biancari F, Perrotti A, Ruggieri VG, Mariscalco G, Dalen M, Dell'Aquila AM, Jonsson K, Ragnarsson S, Di Perna D, Bounader K, Gatti G, Juvonen T, Alkhamees K, Yusuff H, Loforte A, Lechiancole A, Chocron S, Pol M, Spadaccio C, Pettinari M, De Keyzer D, Fiore A, Welp H. Five-year survival after post-cardiotomy veno-arterial extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care. 2021 Aug 24;10(6):595-601. doi: 10.1093/ehjacc/zuaa039.

    PubMed 33580776
  • Mariscalco G, Fiore A, Ragnarsson S, El-Dean Z, Jonsson K, Dalen M, Fux T, Ruggieri VG, Gatti G, Juvonen T, Zipfel S, Dell'Aquila AM, Perrotti A, Bounader K, Settembre N, Loforte A, Livi U, Pol M, Spadaccio C, Pettinari M, Reichart D, Alkhamees K, Welp H, Maselli D, Lichtenberg A, Biancari F; PC-ECMO group. Venoarterial Extracorporeal Membrane Oxygenation After Surgical Repair of Type A Aortic Dissection. Am J Cardiol. 2020 Jun 15;125(12):1901-1905. doi: 10.1016/j.amjcard.2020.03.012. Epub 2020 Mar 31.

    PubMed 32305219

Questions about this trial

What is this clinical trial studying?

An observational study of Acute Heart Failure and Low Output Heart Failure, run by Turku University 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 1 inclusion and 4 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: status not confirmed, as of the sponsor's last update on 11 Mar 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.

Are results available for this study?

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?

Hospital death (time frame: Up to 30 days after the index cardiac surgery). 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 NCT03508505, which also lists 2 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 11 Mar 2020.

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