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Coagulation; IntravascularNCT05033704

Effect of Human Plasma Protein Transfusion With and Without Crystalloids During Major Liver Resection Surgeries

A study testing 5% human plasma protein fraction (PPF) in people with Coagulation; Intravascular and Fluid Electrolyte Disorders, run by Hamad Medical Corporation at 1 site in Qatar.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Evaluation of acid-base and electrolyte changes after administration of commonly used colloid solutions (plasma protein fraction contains 5% albumin), and crystalloids (saline 0.9% and lactated ringers solutions) is the primary endpoint of this study. Read more about this study

Who is it for?
Ages 18 to 70 years
What is being tested?
5% human plasma protein fraction (PPF)
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
48 participants
Where
1 siteQatar
Study dates
9 Sep 2019to 1 Sep 2021
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 18 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 18- 70 years old
  • Not allergic to PPF5%, NS and RL,
  • No morphological or functional cardiac valve/s changes, cardiac ischemia, significant arrhythmias or in failure,
  • Patients with normal liver function tests before surgery and has no chronic active liver disease,
  • Patients with normal kidney functions.

Who cannot join

  • Patients with cardiac disease,
  • Kidney disease,
  • Liver dysfunction,
  • Those who receive additional blood products other than PRBCs.

Trial locations and contacts

1 site in 1 country.

yasser Hammad, M.D. contact

+97433000198

yhammad@hamad.qa

Nabil Shallik, M.D. contact

+97455439264

nshallik@hamad.qa

Qatar1 site, 1 recruiting
  • Hamad Medical Corporation

    Doha, Baladiyat ad Dawhah, 3050

    yasser Hammad, M.D., +974 3300 0198, yhammad@hamad.qa

    Nabil Shallik, +97444393817 ext. Shallik, nshallik@hamad.qa

    Recruiting

Other trials in Qatar

About this study

Official title: Effect of Human Plasma Protein Transfusion With and Without Crystalloids on Acid Base, Electrolytes and Tissue Perfusion During Major Liver Resection Surgeries

Evaluation of acid-base and electrolyte changes after administration of commonly used colloid solutions (plasma protein fraction contains 5% albumin), and crystalloids (saline 0.9% and lactated ringers solutions) is the primary endpoint of this study. The secondary endpoints are to study dilution acidosis and changes in plasma volume induced by albumin versus crystalloids and their effect on tissue perfusion by randomizing patients into two groups where each group receives intraoperatively one type of the two fluids. Changes in acid-base, electrolytes, and dilution acidosis

Read the detailed description

To compare Between PPF 5% and crystalloids in the management of patients undergoing Liver resection and to conclude if any the benefits of treating those patients with high protein content fluids.

Methodology: Each patient will complete a full medical and surgical history and clinical examination.

Routine examinations will include complete blood picture, kidney function tests (serum urea, creatinine, sodium, and potassium), liver function tests (alanine transaminase, aspartate transaminase, prothrombin time and concentration and international normalized ratio, and serum albumin), random blood sugar, and serum electrolytes (Calcium, Chloride bicarbonate and lactate). Patients will be distributed randomly between two groups using a predetermined computer-generated randomized schedule. Twenty-four of the 48 patients will receive an intraoperative intravenous infusion of 5% human plasma protein fraction PPF, (A group). PPF 5%?Octapharma 5 %? is a colloid solution containing (47.6-52.5% proteins, of which 45.6-52.5 gm/L albumin and 142.5-157.5 mmol/L sodium). The remaining 24 patients will receive an intraoperative intravenous infusion of crystalloids (0.9 % normal saline and/ or Lactated Ringer's solution) (RS group). Fluids will be given targeting euvolemic state which is defined as central venous pressure (CVP) 5-10 mmHg or Stroke volume variation (SVV) of? 13%. Central venous pressure (CVP) CVP of -1 to 1 mmHg or Stroke volume variation (SVV) of 18-21% (12) will be targeted during transaction times.

The transfusion trigger will be Hemoglobin of? 8 gm/dl. Any patient who received additional blood products will be excluded from the study. General anesthesia will be induced using Propofol 2% and fentanyl. The ultrasound-guided central venous catheter will be inserted after induction of anesthesia in the right internal jugular vein. Arterial Cather size 20-gauge will be inserted in the radial artery. All patients will receive inhalational anesthesia using Sevoflurane, targeting MAC 1, and be ventilated using the Drager Xeus machine. Tidal volume of 7ml/Kg and zero PEEP will be used for all patients. All patients will receive furosemide 20-40 mg to maintain good diuresis and control central venous pressure. In addition to this, a 30-45 degree head-up position will be maintained. Arterial blood will be drawn through the radial artery catheter before the start of surgery and fluid infusion (time 0), the start of liver resection (time R), after Liver resection (time AR), and at the end of the procedure (time E). Arterial blood gas parameters (using atrial blood gas analyzer machine) including, pH, K+, Cl-, HCO3-, base deficit, and lactate concentrations will be measured. Hemoglobin, hematocrit concentrations, and albumin will be measured and recorded at time 0, R, AR \& E. Intravascular albumin mass will be calculated based on plasma volume (PV) which will be calculated according to Nadler's Formula for calculating total blood volume in adult (TBV) (9, 14): PV = TBV ? (1 ? hematocrit)

Being tested
5% human plasma protein fraction (PPF)
Keywords
Human Plasma Protein, Crystalloids, Liver Resection Surgeries
Medical subject headings
Thrombosis

What participants receive

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

  • 5% human plasma protein fraction (PPF)Drug

    Also called 5% Human Albumen

    Infusion of 5% human plasma protein fraction PPF. PPF 5% "Octapharma 5 %" is a colloid solution containing (47.6-52.5% proteins, of which 45.6-52.5 gm/L albumin and 142.5-157.5 mmol/L sodium).

Study groups in NCT05033704
Study groupRoleWhat they receive
(Group A)ExperimentalTwenty-four of the 48 patients will receive an intraoperative intravenous infusion of 5% human plasma protein fraction PPF, (A group). PPF 5% "Octapharma 5 %" is a colloid solution containing (47.6-52.5% proteins, of which 45.6-52.5 gm/L albumin and 142.5-157.5 mmol/L sodium). Fluids will be given targeting euvolemic state which is defined as central venous pressure (CVP) 5-10 mmHg or Stroke volume variation (SVV) of ≤ 13%. Central venous pressure (CVP) CVP of -1 to 1 mmHg or Stroke volume variation (SVV) of 18-21% (12) will be targeted during transaction times. The transfusion trigger will be Hemoglobin of ≤8 gm/dl.
Receives: Drug: 5% human plasma protein fraction (PPF)
(Group RS)No intervention24 patients will receive an intraoperative intravenous infusion of crystalloids (0.9 % normal saline and/ or Lactated Ringer's solution) (RS group). Fluids will be given targeting euvolemic state which is defined as central venous pressure (CVP) 5-10 mmHg or Stroke volume variation (SVV) of ≤ 13%. Central venous pressure (CVP) CVP of -1 to 1 mmHg or Stroke volume variation (SVV) of 18-21% (12) will be targeted during transaction times. The transfusion trigger will be Hemoglobin of ≤8 gm/dl.

What is being measured

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

  1. Base deficit

    The primary end point of the study will be changes in base deficit in the two groups

    Measured: Intra-operative at the end of the four stages of liver resection

  2. Strong Ion difference

    The primary end point of the study will be changes in strong ion difference in the two groups

    Measured: Intra-operative time at the end of four stages of liver resection

  3. Intra-vascular Albumin content

    The primary end point of the study will be changes in intra-vascular albumin mass in the two groups

    Measured: Intra-operative time at the end of the four stages of liver resection

Secondary outcomes (4)
  1. Kidney functions

    Two group comparison on postoperative serum creatinine and urine output at the end of surgery

    Measured: Urine out put at the end of surgery and postoperative day one serum creatinine

  2. Total blood loss

    Comparing the two groups regarding intra-operative blood loss

    Measured: End of surgery blood loss

  3. Changes in coagulation using Thromboelastogram

    Comparing the coagulation of the two groups at the end of resection and end of surgery

    Measured: At the the end of resection phase and end of surgery

  4. Tissue perfusion index

    statistically comparing tissue perfusion index between the two groups at the 4 surgical times

    Measured: The four intra-operative stages of liver resection

Timeline

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

  1. First posted5 Sep 2021
  2. Study start9 Sep 2019
  3. Primary completion1 Sep 2021 (estimated)
  4. Study completion1 Sep 2021 (estimated)

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
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
48 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05033704
Sponsor's protocol ID
MRC-01-18-256
Status last verified
Jul 2021
First submitted
28 Jul 2021
Last updated
5 Sep 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: A decision regarding sharing information will be taken at later stage

Publications

  • Janeway, C. A.

  • Greasley L, Russell RJ. Albumin and its role in trauma resuscitation. J R Army Med Corps. 2005 Jun;151(2):65-8. doi: 10.1136/jramc-151-02-01. No abstract available.

    PubMed 16097108
  • Ashraf S. Hasanin, Fatma M.A. Mahmoud, Hossam M. Soliman. Factors affecting acid base status during hepatectomy in cirrhotic patients. Egyptian Journal of Anesthesia (2013) 29, 305-310).

  • Semin Thromb Hemost 1980; 6(2): 85-120 DOI: 10.1055/s-2007-1005097

  • Peters T Jr. Serum albumin. Adv Protein Chem. 1985;37:161-245. doi: 10.1016/s0065-3233(08)60065-0. No abstract available.

    PubMed 3904348
  • Quinlan GJ, Martin GS, Evans TW. Albumin: biochemical properties and therapeutic potential. Hepatology. 2005 Jun;41(6):1211-9. doi: 10.1002/hep.20720. No abstract available.

    PubMed 15915465
  • Tullis JL. Albumin. 1. Background and use. JAMA. 1977 Jan 24;237(4):355-60 CONTD. doi: 10.1001/jama.237.4.355. No abstract available.

    PubMed 576167
  • Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossettias G; Italian Society of Transfusion Medicine and Immunohaematology (SIMTI). Recommendations for the use of albumin and immunoglobulins. Blood Transfus. 2009 Jul;7(3):216-34. doi: 10.2450/2009.0094-09. No abstract available.

    PubMed 19657486
  • Pusey C, Dash C, Garrett M, Gascoigne E, Gesinde M, Gillanders K, Wallington T. Experience of using human albumin solution 4.5% in 1195 therapeutic plasma exchange procedures. Transfus Med. 2010 Aug 1;20(4):244-9. doi: 10.1111/j.1365-3148.2010.00999.x. Epub 2010 Mar 11.

    PubMed 20230532
  • Dill DB, Costill DL. Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. J Appl Physiol. 1974 Aug;37(2):247-8. doi: 10.1152/jappl.1974.37.2.247. No abstract available.

    PubMed 4850854
  • Goodkin DA, Raja RM, Saven A. Dilutional acidosis. South Med J. 1990 Mar;83(3):354-5. doi: 10.1097/00007611-199003000-00029.

    PubMed 2315790
  • Mathes DD, Morell RC, Rohr MS. Dilutional acidosis: is it a real clinical entity? Anesthesiology. 1997 Feb;86(2):501-3. doi: 10.1097/00000542-199702000-00028. No abstract available.

    PubMed 9054271
  • Dunki-Jacobs EM, Philips P, Scoggins CR, McMasters KM, Martin RC 2nd. Stroke volume variation in hepatic resection: a replacement for standard central venous pressure monitoring. Ann Surg Oncol. 2014 Feb;21(2):473-8. doi: 10.1245/s10434-013-3323-9. Epub 2013 Oct 23.

    PubMed 24150192
  • Norberg A, Rooyackers O, Segersvard R, Wernerman J. Leakage of albumin in major abdominal surgery. Crit Care. 2016 Apr 26;20(1):113. doi: 10.1186/s13054-016-1283-8.

    PubMed 27117323
  • Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962 Feb;51(2):224-32. No abstract available.

    PubMed 21936146

Questions about this trial

What is this clinical trial studying?

A study testing 5% human plasma protein fraction (PPF) in people with Coagulation; Intravascular and Fluid Electrolyte Disorders, run by Hamad Medical Corporation at 1 site in Qatar.

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 5 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 5 Sep 2021. 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 Qatar. 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?

Contact yasser Hammad, M.D. (+97433000198, yhammad@hamad.qa), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Base deficit (time frame: Intra-operative at the end of the four stages of liver resection). The study lists 3 primary outcomes in all. 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 NCT05033704, which also lists 15 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 5 Sep 2021.

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