Blood Conservation in Cardiac Surgery
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Purpose
The objective of the study is to examine the safety of two different hemoglobin (Hgb)-based transfusion triggers in patients post cardiac surgery.
| Condition | Intervention |
|---|---|
|
Transfusion Reactions Post Cardiac Surgery |
Other: Blood transfusion |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Prevention |
| Official Title: | Blood Conservation in Cardiac Surgery |
- Safety of the lower hemoglobin transfusion trigger of 7.5 g/dl against the higher hemoglobin transfusion trigger of 9.0 g/dl. [ Time Frame: The assessment will last untill day 4 post surgery ] [ Designated as safety issue: Yes ]This outcome measure is a simultaneous assessment of the multiple end points duration of pressor use, symptomatic anemia, anemia-associated hypotension within 48 hours post surgery and Hgb recovery by day 4 post-surgery.
- Rate of incidence of transfusion related complications between the two randomizations arms. [ Time Frame: This will be compared during the hospital stay, untill 30 days after discharge. ] [ Designated as safety issue: Yes ]The comparison will be based on a composite end point consisting of transfusion related lung injury (TRALI) that is ARDS, ventilator time>24 hours, pneumonia; stroke (permanent/transient); MI and renal failure.
| Estimated Enrollment: | 900 |
| Study Start Date: | November 2011 |
| Estimated Study Completion Date: | November 2013 |
| Estimated Primary Completion Date: | November 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Conservative Transfusion Arm
Subjects in the conservative transfusion arm will receive transfusion only when their hemoglobin levels reach 7.5 g/dl.
|
Other: Blood transfusion
Conservative transfusion arm: Subjects randomized to the conservative transfusion arm will receive transfusions of PRBCs post-surgery only when their Hgb level measures < 7.5 g/dl. Blood products should be given to maintain Hgb levels >7.5 g/dl.
|
|
Active Comparator: Liberal Transfusion Arm
Subjects in the liberal transfusion arm will receive transfusion only when their hemoglobin levels reach 9.0 g/dl.
|
Other: Blood transfusion
Liberal transfusion arm: Subjects randomized to the liberal transfusion arm will receive transfusions of PRBCs post-surgery only when their Hgb level measures < 9.0 g/dl. Blood products should be given to maintain Hgb levels > 9.0 g/dl.
|
Detailed Description:
Nearly 20% of blood transfusions in the United States are given to in patients undergoing cardiac surgery. Despite the many blood conservation techniques that are available, safe, and efficacious for patients, many of these operations continue to be associated with significant amounts of blood usage. We believe that transfusion protocols which employ specific guidelines for transfusion can decrease blood product usage and improve outcomes for patients undergoing cardiac surgery. Our goal is to demonstrate that a carefully chosen trigger can achieve better outcomes.
Our hypothesis is that a transfusion trigger of Hgb 7.5 g/dl will lead to decreased utilization of blood transfusions and will have many positive effects on the patients post cardiac surgery in addition to substantial cost savings. We will use an evidence based approach to observe the relative safety of a conservative transfusion trigger (7.5 g/dl) as compared to a more liberal trigger (9.0 g/dl). We will also study the effect of blood conservation on the incidence of transfusion-related complications such as transfusion related lung injury (TRALI) and infectious complications as well as length of hospital stay, cost and ventilator time.
Eligibility| Ages Eligible for Study: | 21 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Subjects who meet all of the following criteria will be considered for inclusion in this study:
Subjects scheduled to undergo any of the following cardiac surgeries as part of their routine medical care:
- CABG
- AVR
- MVR
- MV Repair
- CABG/AVR
- CABG/MVR
- CABG/MV Repair
- Thoracic Aneurysm Repair ± any concomitant cardiac procedure (valve, CABG, etc.)
- Subjects must be > 18 years of age
- No prior history of cardiac surgery.
- Able and willing to give informed consent
Exclusion Criteria:
Subjects who meet any of the following criteria will be excluded from participation in this study:
- Prior history of cardiac surgery
- Patients who do not have sufficient time prior to surgery to give proper informed consent (i.e.: immediate, emergency surgery)
- Patients who are younger than 18 years of age
Prior history of
- bleeding disorders
- symptomatic anemia (i.e. persistent tachycardia, orthostatic hypotension, persistent pressor requirement)
- hereditary/acquired coagulopathy
- platelet defects (e.g.: disseminated intravascular coagulation (DIC), hemophilia, Henoch-Schönlein purpura, hereditary hemorrhagic telangiectasia, thrombocytopenia (ITP, TTP), thrombophilia, Von Willebrand's disease)
- History of leukemia or any other blood related malignancy
- History of liver failure
- Current, or history of, pre-existing medical condition other than current cardiac condition, which in the opinion of the investigator, would place the subject at risk or have the potential to confound interpretation of the study results
- Participation in another clinical trial
- Lack of capacity to give informed consent.
Contacts and Locations| Contact: Tammy Russo, MMS, APN | 201-996-4838 | TRusso@humed.com |
| United States, New Jersey | |
| Hackensack University Medical Center | Active, not recruiting |
| Hackensack, New Jersey, United States, 07601 | |
| Principal Investigator: | Leonard Lee, M.D. | Hackensack University Medical Center |
More Information
No publications provided
| Responsible Party: | Leonard Lee, MD, Chief of Cardiothoracic Surgery, Vice Chairman of the Heart & Vascular Hospital, Hackensack University Medical Center, Hackensack University Medical Center |
| ClinicalTrials.gov Identifier: | NCT01463345 History of Changes |
| Other Study ID Numbers: | Pro00001949 |
| Study First Received: | October 27, 2011 |
| Last Updated: | October 31, 2011 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Hackensack University Medical Center:
|
Blood conservation Transfusion Hemoglobin trigger |
Transfusion trigger Cardiac surgery Transfusion triggers post cardiac surgery |
Additional relevant MeSH terms:
|
Blood Group Incompatibility Hematologic Diseases Immune System Diseases |
ClinicalTrials.gov processed this record on May 16, 2013