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Endothelial DysfunctionPRIME part IINCT05647200

Optimization of Prime Fluid Strategy to Preserve Microcirculatory Perfusion During Cardiac Surgery With Cardiopulmonary Bypass, Part II

A study testing Treatment: additional albumin during cardiopulmonary bypass in people with Endothelial Dysfunction and Hemolysis, run by Amsterdam UMC, location VUmc at 1 site in Netherlands.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Acute microcirculatory perfusion disturbances is common in critical illness and associated with increased morbidity and mortality. Recent findings by our group showed that microcirculatory perfusion is disturbed during cardiac surgery with cardiopulmonary bypass (CPB) and remain disturbed up to 72 (seventy two) hours… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Endothelial Dysfunction, Hemolysis, Fluid Overload
What is being tested?
Treatment: additional albumin during cardiopulmonary bypass
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
64 participants
Where
1 siteNetherlands
Study dates
15 Oct 2023to 15 Jan 2025
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult subjects
  • Informed consent
  • Elective coronary artery bypass surgery with cardiopulmonary bypass

Who cannot join

  • Emergency operations
  • Re-operation
  • Elective thoracic aortic surgery
  • Elective valve surgery
  • Combined procedure CABG and valve surgery
  • Known allergy for human albumin or gelofusine

Trial locations and contacts

1 site in 1 country.

A.M. Beukers, MD contact

020-4444444

a.beukers@amsterdamumc.nl

A.B.A. Vonk, MD PhD contact

020-4444444

Netherlands1 site
  • Amsterdam UMC, AMC location

    Amsterdam, North Holland, 1105AZ

Other trials in Netherlands

About this study

Official title: Optimization of Prime Fluid Strategy to Preserve Microcirculatory Perfusion During Cardiac Surgery With Cardiopulmonary Bypass

Acute microcirculatory perfusion disturbances is common in critical illness and associated with increased morbidity and mortality. Recent findings by our group showed that microcirculatory perfusion is disturbed during cardiac surgery with cardiopulmonary bypass (CPB) and remain disturbed up to 72 (seventy two) hours after surgery. A cardiopulmonary bypass is a machine which takes over heart and lung function, during the procedure. The disturbed microcirculation is associated with organ dysfunction induced by cardiac surgery using CPB, which is frequently seen (up to forty two percent, 42%) and results in a six-fold increase in mortality rate. The underlying cause of disturbed microcirculation is a higher endothelial permeability and vascular leakage and are a consequence of systemic inflammation, hemodilution (dilution of blood), hypothermia and hemolysis (breakdown of red blood cells). To gain the knowledge regarding disturbed microcirculation the investigators previously showed that hemodilution attributes to this disturbed perfusion. Hemodilution lowers colloid oncotic pressure (COP). Also, COP is affected by free hemoglobin, which increases with hemolysis and attributes to a disturbed microcirculation following CPB. This is interesting, as to the best of our knowledge, the effect of minimizing hemodilution and hemolysis during cardiac surgery on the microcirculatory perfusion has never been investigated, but could be the key factor in reducing organ dysfunction.

Read the detailed description

In this project the investigators focus on reducing microcirculatory perfusion disturbances by exploring therapeutic approaches with different prime fluid strategies, by acting on COP (part I) and free hemoglobin scavenging with human albumin (part II).

In part I, patients undergoing elective coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass will be randomized in three groups receiving different prime fluid strategies. The study endpoint is the reduction in functional capillary density during the perioperative period. Sublingual microcirculatory measurements and blood sampling will take place after induction of anesthesia, during and after surgery to determine microcirculatory perfusion and parameters for hemodilution, hemolysis, COP, markers for endothelial damage and glycocalyx shedding. Measurements start on the day of surgery and end one day after surgery. For part I see trial registration: PRIME, part I.

In part II, participants will be randomized in two groups receiving the first dose directly after aortic cross clamping and blood cardioplegia administration, and the second dose after the third blood cardioplegia administration (± 30 min after the first dose).The most optimal prime fluid in order to preserve microcirculatory perfusion from study one, will be used as prime fluid in the second study. Microcirculatory perfusion parameters will be measured at time points comparable with study one. Blood samples are taken to determine markers for hemodilution, hemolysis, COP and endothelial damage and glycocalyx shedding.

Being tested
Treatment: additional albumin during cardiopulmonary bypass, control: additional ringers during cardiopulmonary bypass
Keywords
Microcirculation, Cardiopulmonary bypass, Colloid oncotic pressure, Hemodilution, Hemolysis
Medical subject headings
Hemolysis, Edema

What participants receive

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

  • Treatment: additional albumin during cardiopulmonary bypassDrug

    Treatment group (T): administration of 100 mL Human Albumin (20%), first dose directly after aortic cross clamping and blood cardioplegia administration, second dose after the third blood cardioplegia administration (± 30 min after the first dose).

  • control: additional ringers during cardiopulmonary bypassDrug

    Control group (C): administration of 100 mL of Ringer's solution, first dose directly after aortic cross clamping and blood cardioplegia administration, second dose after the third blood cardioplegia administration (± 30 min after the first dose).

Study groups in NCT05647200
Study groupRoleWhat they receive
T (Treatment)Active comparatorThe most optimal prime fluid from part I (based on the effect on perfused vessel density) + additional albumin during cardiopulmonary bypass.
Receives: Drug: Treatment: additional albumin during cardiopulmonary bypass
C (control)Sham comparatorThe most optimal prime fluid from part I (based on the effect on perfused vessel density) + additional ringers during cardiopulmonary bypass.
Receives: Drug: control: additional ringers during cardiopulmonary bypass

What is being measured

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

  1. Perfused vessel density (PVD, mm mm-²)

    reflecting microcirculatory diffusion capacity

    Measured: Timepoint 1: 5-10 min after induction of anesthesia

  2. Perfused vessel density (PVD, mm mm-²)

    reflecting microcirculatory diffusion capacity

    Measured: Timepoint 2: 5-10 min after aortic cross clamping

  3. Perfused vessel density (PVD, mm mm-²)

    reflecting microcirculatory diffusion capacity

    Measured: Timepoint 3: 5-10 min after weaning from cardiopulmonary bypass

  4. Perfused vessel density (PVD, mm mm-²)

    reflecting microcirculatory diffusion capacity

    Measured: Timepoint 4: 15-30 min after arrival on the intensive care unit

  5. Perfused vessel density (PVD, mm mm-²)

    reflecting microcirculatory diffusion capacity

    Measured: Timepoint 5: twenty four (24) hours after arrival on the intensive care unit

Secondary outcomes (15)
  1. Colloid oncotic pressure (COP, mmHg)

    colloid oncotic pressure in plasma

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  2. albumin (g L-¹)

    concentration of albumin in plasma

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  3. hemolysis index (H-index)

    the grade of hemolysis in plasma

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  4. haptoglobin (g L-¹)

    concentration of haptoglobin in plasma

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  5. NO consumption (μmol L-¹)

    consumption of nitric oxide in plasma

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  6. syndecan-1 (ng/ml)

    Concentration of syndecan-1 in plasma

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  7. heparan sulphate (ng/ml)

    concentration of heparan sulphate in plasma

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  8. hemoglobin (Hb, mmol L-¹)

    concentration of hemoglobin in serum

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  9. hematocrit (Ht, L L-¹)

    hematocrit in serum

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  10. perioperative use of packed red blood cells (PRBCs, mL)

    amount of packed red blood cells

    Measured: intraoperative and postoperative up to 24 hours postoperative

  11. fluid balance (mL)

    fluid balance

    Measured: intraoperative and postoperative up to 24 hours postoperative

  12. fluid requirements (mL)

    Amount of fluids required

    Measured: intraoperative and postoperative up to 24 hours postoperative

  13. Total vessel density (TVD, mm mm-²)

    density of capillaries reflecting the functional state of the microcirculatory diffusion capacity

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  14. Proportion of perfused vessels (PPV, %)

    reflecting the aspect of heterogeneity of microcirculatory perfusion

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

  15. Heterogeneity index

    reflecting the aspect of heterogeneity of microcirculatory perfusion

    Measured: T1, 5-10 min after induction of anesthesia; T2, 5-10 min after aortic cross clamping; T3, 5-10 min after weaning from cardiopulmonary bypass; T4, 15-30 min after arrival on the intensive care unit; T5, 24 hours after arrival on the intensive care unit.

Timeline

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

  1. First posted12 Dec 2022
  2. Study start15 Oct 2023 (estimated)
  3. Primary completion15 Jul 2024 (estimated)
  4. Study completion15 Jan 2025 (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
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
In two consecutive randomized controlled trials, we study the effect of prime fluid strategies on perfused vessel density (part I) and the effect of additional albumin during cardiopulmonary bypass compared with ringers on perfused vessel density (part II). In this study part (II), the effect of additional albumin during cardiopulmonary bypass compared with ringers on perfused vessel density.
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
64 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05647200
Sponsor's protocol ID
NL82500.029.22, part II
Acronym
PRIME part II
Status last verified
Apr 2023
First submitted
21 Nov 2022
Last updated
26 Apr 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Upon request

Questions about this trial

What is this clinical trial studying?

A study testing Treatment: additional albumin during cardiopulmonary bypass in people with Endothelial Dysfunction and Hemolysis, run by Amsterdam UMC, location VUmc at 1 site in Netherlands.

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 3 inclusion and 6 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 26 Apr 2023. 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 Netherlands. 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. Some participants in this study may receive a placebo. 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 A.M. Beukers, MD (020-4444444, a.beukers@amsterdamumc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Perfused vessel density (PVD, mm mm-²) (time frame: Timepoint 1: 5-10 min after induction of anesthesia). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 26 Apr 2023.

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