Thermogard™ Efficacy Trial

NCT ID: NCT00822796

Last Updated: 2013-07-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

9 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-09-30

Study Completion Date

2009-10-31

Brief Summary

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The purpose of this study is to determine if the Thermogard™ central venous catheter can prevent hypothermia (defined as a core body temperature less then 36.0 °C) in severely burned patients who are undergoing surgery for debridement and grafting in the setting of reduced ambient room temperature.

Detailed Description

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Hypothermia in the severely burned has been shown to disrupt coagulation, impair myocardial function, weaken the host immune response, delay wound healing and increase mortality.

Current methods available for preventing and reversing hypothermia include administering heated, humidified oxygen, infusing warmed intravenous fluids centrally, performing peritoneal dialysis with warmed fluid, undergoing extracorporeal blood warming with partial bypass, and markedly increasing the ambient room temperature. These methods are either limited in their effectiveness or are impractical and potentially dangerous. Furthermore, the practice of markedly increasing the ambient room temperature creates a hostile work environment for health care providers which may impact patient care.

The FDA has classified the Alsius Thermogard™ heat exchange catheter as a Class II devices under 21 C.F.R §§ 870.5900. It is used in various clinical applications for cooling patients but it has not been FDA-approved for use in warming burn patients. The Thermogard™ is an integrated electro-mechanical heater/cooler that consists of a temperature monitor, a temperature controller unit, a heat exchanger unit, and roller pump. It supplies temperature controlled sterile saline to the indwelling catheter that is placed percutaneously in the patient. The catheter can be placed in the femoral vein (larger catheter with three heat exchange balloons) or the subclavian or jugular vein (smaller catheter with two heat exchange balloons).

Sterile saline is warmed (to a maximum temperature of 38 °C) in the external device and then pumped through the balloons coaxially mounted on the catheter, enabling direct warming of the blood. The catheter contains a temperature probe enabling a 'closed loop' temperature control system; the temperature is set at the desired level (the range of the device is 28-38°C, which may vary according to the installed software), after which the device warms the patient to this level by increasing or decreasing the temperature of the circulating saline. The core temperature is then maintained at the desired level for as long as the attending physician deems necessary. The catheter also has two ports for central venous access, which can be used to administer medication and/or for blood sampling.

The purpose of this study is to determine if the Thermogard™ central venous catheter can significantly impact the heat stress environment of the operating room by allowing severely burned patients to undergo surgery for debridement and grafting at lower ambient operating room temperatures when compared to control subjects.

Conditions

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Hypothermia Burns

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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A

Burn patients with \>20% TBSA burns scheduled to undergo debridement and grafting who will have placed the Thermogard™ central venous warming catheter by Alsius

Group Type EXPERIMENTAL

Thermogard™

Intervention Type DEVICE

Those who have a Thermogard™ central venous warming catheter placed prior to surgery

B

Burn patients with \>20% TBSA burns scheduled to undergo debridement and grafting who will have placed a central venous catheter as a part of their routine burn management

Group Type ACTIVE_COMPARATOR

Standard central venous catheter

Intervention Type DEVICE

Those who have a standard central venous catheter placed prior to surgery

Interventions

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Thermogard™

Those who have a Thermogard™ central venous warming catheter placed prior to surgery

Intervention Type DEVICE

Standard central venous catheter

Those who have a standard central venous catheter placed prior to surgery

Intervention Type DEVICE

Other Intervention Names

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Rewarming

Eligibility Criteria

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Inclusion Criteria

* Adult males and non-pregnant females ages 18-70 with greater than 20% TBSA burns requiring excision and grafting and in need of a central venous catheter per ICU admission criteria.
* Patient or patient's surrogate must be able to verbalize understanding and willingness to participate in the study and provide written informed consent

Exclusion Criteria

* Pregnancy. All females admitted to the burn ICU undergo routine serum hCG to determine pregnancy status. Those found to be pregnant will be excluded from entry into the study
* Burn patients enrolled in recombinant Factor VII study due to the theoretical increased risk for clot formation
* Basic and advanced enlisted trainees
* Age greater than 70 years old due to increased mortality rate among those severely burned
* Conditions which make placement of a central venous catheters a greater than normal risk (vascular anomalies, previous vascular surgery, etc.)
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Brooke Army Medical Center

FED

Sponsor Role lead

Responsible Party

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Timothy F. Haley

Division Surgeon

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Timothy F. Haley, MD

Role: PRINCIPAL_INVESTIGATOR

Brooke Army Medical Center

Steven E. Wolf, MD

Role: STUDY_DIRECTOR

US Army Institute of Surgical Research

References

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Jurkovich GJ, Greiser WB, Luterman A, Curreri PW. Hypothermia in trauma victims: an ominous predictor of survival. J Trauma. 1987 Sep;27(9):1019-24.

Reference Type BACKGROUND
PMID: 3656464 (View on PubMed)

Robinson S, Katariya K, et al. Perioperative temperature management: Roundtable discussion identifies need to avoid hypothermia. Minutes from the Anesthesia Patient Safety Foundation. 11 June 2005; Louisville, KY

Reference Type BACKGROUND

Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, Beattie C. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997 Apr 9;277(14):1127-34.

Reference Type BACKGROUND
PMID: 9087467 (View on PubMed)

Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996 May 9;334(19):1209-15. doi: 10.1056/NEJM199605093341901.

Reference Type BACKGROUND
PMID: 8606715 (View on PubMed)

Doufas AG. Consequences of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. 2003 Dec;17(4):535-49. doi: 10.1016/s1521-6896(03)00052-1.

Reference Type BACKGROUND
PMID: 14661656 (View on PubMed)

Weinberg AD. Hypothermia. Ann Emerg Med. 1993 Feb;22(2 Pt 2):370-7. doi: 10.1016/s0196-0644(05)80467-6.

Reference Type BACKGROUND
PMID: 8434836 (View on PubMed)

Gore DC, Beaston J. Infusion of hot crystalloid during operative burn wound debridement. J Trauma. 1997 Jun;42(6):1112-5. doi: 10.1097/00005373-199706000-00022.

Reference Type BACKGROUND
PMID: 9210551 (View on PubMed)

Soung LS, Swank L, Ing TS, Said RA, Goldman JW, Perez J, Geis WP. Treatment of accidental hypothermia with peritoneal dialysis. Can Med Assoc J. 1977 Dec 17;117(12):1415-6. No abstract available.

Reference Type BACKGROUND
PMID: 589543 (View on PubMed)

Wong PS, Pugsley WB. Partial cardiopulmonary bypass for the treatment of profound accidental hypothermic circulatory collapse. J R Soc Med. 1992 Oct;85(10):640. doi: 10.1177/014107689208501021. No abstract available.

Reference Type BACKGROUND
PMID: 1433050 (View on PubMed)

El-Gamal N, Elkassabany N, Frank SM, Amar R, Khabar HA, El-Rahmany HK, Okasha AS. Age-related thermoregulatory differences in a warm operating room environment (approximately 26 degrees C). Anesth Analg. 2000 Mar;90(3):694-8. doi: 10.1097/00000539-200003000-00034.

Reference Type BACKGROUND
PMID: 10702459 (View on PubMed)

Hancock PA, Vasmatzidis I. Effects of heat stress on cognitive performance: the current state of knowledge. Int J Hyperthermia. 2003 May-Jun;19(3):355-72. doi: 10.1080/0265673021000054630.

Reference Type BACKGROUND
PMID: 12745975 (View on PubMed)

Koenders S, Struijs A, et al, Feasibility of an intravenous warming device to rewarm cardiac surgery patients. NJCC 2004;8:34.

Reference Type BACKGROUND

Karabinis A, Mandila C, Koukoulitsios G, Dounis G, Tsoutsos D. Using an intravascular device to reverse refractory burn-associated hypothermia. Anaesth Intensive Care. 2008 Nov;36(6):918-9. No abstract available.

Reference Type BACKGROUND
PMID: 19117092 (View on PubMed)

Willekes T, Naunheim R, Lasater M. A novel method of intravascular temperature modulation to treat severe hypothermia. Emerg Med J. 2006 Oct;23(10):e56. doi: 10.1136/emj.2006.035360.

Reference Type BACKGROUND
PMID: 16988294 (View on PubMed)

Arthurs Z, Cuadrado D, Beekley A, Grathwohl K, Perkins J, Rush R, Sebesta J. The impact of hypothermia on trauma care at the 31st combat support hospital. Am J Surg. 2006 May;191(5):610-4. doi: 10.1016/j.amjsurg.2006.02.010.

Reference Type BACKGROUND
PMID: 16647346 (View on PubMed)

Other Identifiers

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CIRO 2008235

Identifier Type: -

Identifier Source: secondary_id

I.2008.030

Identifier Type: -

Identifier Source: org_study_id

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