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Cytokine Removal in Cardiopulmonary Bypass Patients (CytoSorb)

This study has been completed.
Sponsor:
Collaborator:
CytoSorbents, Inc
Information provided by (Responsible Party):
Dr. Martin Bernardi, Medical University of Vienna
ClinicalTrials.gov Identifier:
NCT01879176
First received: June 7, 2013
Last updated: January 9, 2017
Last verified: January 2017
  Purpose

Cardiopulmonary bypass (CPB) surgery initiates a systemic inflammatory response induced by extrinsic (e.g. anesthesia, contact activation within the extracorporeal circuit, endotoxemia) and intrinsic (e.g. tissue damage, endothelial cell activation, ischemia-reperfusion injury of myocardium) factors. Monocytes are important players in systemic inflammation and the main producers of pro- and antiinflammatory cytokines. Monocytes activated by the extracorporeal circuit lead to a dysregulation of inflammatory homeostasis, increased levels of proinflammatory plasma mediators such as TNF-a, IL-1β, IL-6 and IL-18 are joined by antiinflammatory cytokines such as IL-10. This strong inflammatory response induces post surgical monocyte immunosuppression which is indicated by an impaired production of ex vivo LPS induced TNF-a production. Also malfunction of the peripheral circulation with increased lactate levels, pronounced fluid accumulation, increased need of vasopressors and cerebral dysfunction are observed. All of these factors may delay weaning from the ventilator, recovery of organ functions and discharge from ICU. Thus measures to decrease the inflammatory process have the potential to improve the perioperative course.

Use of cytokine adsorbing circuit during CBP has an effect on circulation cytokine levels for the first 36 hours after surgery and induces a decreased inflammatory response for up to 3 days post surgery.


Condition Intervention Phase
Elective Cardiac Surgical Interventions
Device: CytoSorb
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Participant)
Primary Purpose: Treatment
Official Title: Effect of Cytokine Removal in Cardiopulmonary Bypass Patients Using the Cytosorb ™ Filter

Further study details as provided by Dr. Martin Bernardi, Medical University of Vienna:

Primary Outcome Measures:
  • IL-6 [ Time Frame: 1. Preoperative 2. Before CBP 3. After CPB 4. 2 hours after CPB 5. 24 hours 6. 48 hours 7. 120 hours ]

Enrollment: 46
Study Start Date: August 2013
Study Completion Date: May 2015
Primary Completion Date: May 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: CytoSorb
For the intervention group, the CytoSorb filter will be installed on the CPB machine in a parallel circuit to the body circulation. The flow through the filter will be driven by a roller pump with 200ml.min-1 .
Device: CytoSorb
Other Names:
  • Polymer Based Adsorption Systems
  • ISO 13485:2003
No Intervention: Control
No filter will be installed on the CPB machine.

Detailed Description:

Patients, who have an elective cardiac surgical intervention with an expected CBP duration >120 minutes (e.g.: valve surgery, coronary artery bypass graft (CABG), combined procedures) will be enrolled to the study after given informed consent.

Patients, who decline will be asked to collect their secondary outcome data to create a "real - life" group and increase the number of patients in the control group. In this "real - life" group no additional blood samples will be taken.

  Eligibility

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • elective cardiac surgical intervention with an expected CBP duration >120 minutes

Exclusion Criteria:

  • Emergency procedures
  • Heart transplantation
  • Elective left ventricular assist device (LVAD) implantation
  • Pulmonary thromendarterectomy
  • Declined informed consent
  • Serum creatinine > 2mg/dl
  • Body mass index < 18
  • Age < 18 years
  • Pregnant woman
  • Receiving chemotherapy or diagnosed with any disease state (e.g., AIDS) that has produced leukopenia
  • Receiving antileukocyte drugs
  • Receiving TNF-α Blockers, immunosuppressive drugs (e.g. tocilizumab)
  • CRP > 2mg/dl
  • History of Stroke
  • Bilirubin >2mg/dl
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01879176

Locations
Austria
Divison of Cardiothoracic Anaesthesia and Intensive Care, Medical University of Vienna
Vienna, Austria, 1090
Sponsors and Collaborators
Medical University of Vienna
CytoSorbents, Inc
Investigators
Study Director: Michael Hiesmayr, MD Medical University of Vienna
Principal Investigator: Martin H Bernardi, MD Medical University of Vienna
Study Chair: Harald Rinösl, MD Medical University of Vienna
Study Chair: Friedrich Hoffelner General Hospital of Vienna
Study Director: Andreas Spittler, MD Medical University of Vienna
Study Chair: Dominik Wiedemann, MD Medical University of Vienna
Study Chair: Philipp Opfermann, MD Medical University of Vienna
  More Information

Publications:
Responsible Party: Dr. Martin Bernardi, Doctor, Medical University of Vienna
ClinicalTrials.gov Identifier: NCT01879176     History of Changes
Other Study ID Numbers: 1095/2013
Study First Received: June 7, 2013
Results First Received: April 30, 2016
Last Updated: January 9, 2017
Individual Participant Data  
Plan to Share IPD: No

ClinicalTrials.gov processed this record on May 25, 2017