Damage Control Laparotomy

NCT ID: NCT02706041

Last Updated: 2021-11-18

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

39 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-07-01

Study Completion Date

2020-04-30

Brief Summary

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Randomized study to compare outcomes of patients undergoing damage control laparotomies versus definitive closure for which there is surgeon equipoise to randomize.

Detailed Description

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Single center, prospective, randomized study involving seriously injure patients requiring an emergent laparotomy within 90 minutes of arrival to the emergency department. There are situations in which the patient is unable to be closed at the end of the emergent laparotomy (identified as damage control) and there are situations in which the injury has been treated and the incision can be closed (definitive). There are also situations where it is not clear if the patient should be kept open or closed and the result of the surgery varies based on the surgeon performing the case.

The eligible subjects for this study will be randomized toward the end of the emergent laparotomy procedure on a 1:1 basis and will be followed throughout the hospitalization for complications. Patients will also be contacted at 6 month to complete a quality of life questionnaire.

Conditions

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Other Injury of Other Intra-abdominal Organs, Initial Encounter

Keywords

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Exploratory Lap (Ex Lap) Damage Control Laparotomy (DCL) Definitive

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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Definitive closure laparotomy

Subjects randomized to the definitive closure laparotomy arm will have the incision closed at the end of the exploratory laparotomy.

Group Type ACTIVE_COMPARATOR

Definitive Closure Laparotomy

Intervention Type PROCEDURE

Subjects randomized to the definitive closure laparotomy arm will have the incision closed at the end of the exploratory laparotomy.

Damage control laparotomy

Subjects randomized to the damage control laparotomy arm will have the incision left open at the end of the exploratory laparotomy. The trauma team will evaluate the patient's clinical course to determine when the incision can be closed.

Group Type OTHER

Damage Control Laparotomy

Intervention Type PROCEDURE

Subjects randomized to the damage control laparotomy arm will have the incision left open at the end of the exploratory laparotomy. The trauma team will evaluate the patient's clinical course to determine when the incision can be closed.

Interventions

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Definitive Closure Laparotomy

Subjects randomized to the definitive closure laparotomy arm will have the incision closed at the end of the exploratory laparotomy.

Intervention Type PROCEDURE

Damage Control Laparotomy

Subjects randomized to the damage control laparotomy arm will have the incision left open at the end of the exploratory laparotomy. The trauma team will evaluate the patient's clinical course to determine when the incision can be closed.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Emergent laparotomy
* Patient has injuries for which surgeon has equipoise to perform a Definitive (DEF) or Damage Control Laparotomy (DCL)
* Age ≥16 years (age cut-off for admission to adult trauma service at Memorial Hermann Hospital-Texas Medical Center)

Exclusion Criteria

* Indication for DCL for which there is no surgeon equipoise:

* Need for gauze packing of liver or retroperitoneum for hemorrhage control
* Immediate need to go to Interventional Radiology for hemorrhage control
* Concern for Abdominal Compartment Syndrome - defined as physically unable to re-approximate fascia or \>10mmHg change in peak airway pressure during fascial closure
* Hemodynamic instability - defined as persistent hypotension, ongoing transfusion requirement, or continuous vasopressor use
* Indication for DEF for which there is no surgeon equipoise:

* Negative and non-therapeutic laparotomies
* Isolated cystorrhaphy
* Prisoners
* Known pregnancy
* Patients with burns \> 20% of total body surface area
* Patient/legally authorized representative opted out of exception from informed consent (opt out bracelet)
* Currently enrolled in another interventional study
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Center for Advancing Translational Sciences (NCATS)

NIH

Sponsor Role collaborator

The University of Texas Health Science Center, Houston

OTHER

Sponsor Role lead

Responsible Party

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John Andrew Harvin

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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John Harvin, MD

Role: PRINCIPAL_INVESTIGATOR

The University of Texas Health Science Center, Houston

Locations

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Memorial Hermann Hospital - Texas Medical Center

Houston, Texas, United States

Site Status

Countries

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United States

References

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Harvin JA, Podbielski J, Vincent LE, Fox EE, Moore LJ, Cotton BA, Wade CE, Holcomb JB. Damage control laparotomy trial: design, rationale and implementation of a randomized controlled trial. Trauma Surg Acute Care Open. 2017 Apr 13;2(1):e000083. doi: 10.1136/tsaco-2017-000083. eCollection 2017.

Reference Type BACKGROUND
PMID: 29766087 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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UL1TR000371

Identifier Type: NIH

Identifier Source: secondary_id

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KL2TR000370

Identifier Type: NIH

Identifier Source: secondary_id

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HSC-GEN-16-0104

Identifier Type: -

Identifier Source: org_study_id