Hemoadsorption for Prevention of Vasodilatory Shock in Cardiac Surgery Patients With Infective Endocarditis

NCT ID: NCT03266302

Last Updated: 2025-03-18

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

COMPLETED

Clinical Phase

NA

Total Enrollment

288 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-01-17

Study Completion Date

2020-12-31

Brief Summary

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Infective endocarditis (IE) is associated with high hospital mortality for various reasons; one of them is circulatory failure in patients who undergo cardiac surgery for IE. One discussed reason underlying circulatory failure during surgery is the release of vasodilatatory mediators and cytokines. This study examines the efficacy and safety of a hemoadsorption filter which is approved for the reduction of the concentration of cytokines in the bloodstream.

Detailed Description

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The investigators assume a common standard deviation of 3.8 points and that a 1.4-point lower SOFA score in the Intervention Group is of clinical relevance.

Conditions

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Infective Endocarditis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

two-arm randomized-controlled group sequential (Pocock) design for assessing superiority and safety
Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants
Participant will not be informed about group allocation

Study Groups

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Interventional group

Use of hemoadsorber for removal of cytokines. Participants undergoing cardiac surgery due to infective endocarditis will be treated using a hemoadsorption device (CytoSorb) within the cardiopulmonary Bypass circuit (=Intervention)

Group Type EXPERIMENTAL

hemoadsorber for removal of cytokines

Intervention Type DEVICE

Use of the hemoadsorber during cardiac surgery with CPB. Hemoadsorber is integrated into the CPB circuit according to manufacturer's recommendation.

Control group

Participants undergoing cardiac surgery due to infective endocarditis will be treated according to Standard of care (no hemoadsorption advice installed in the CPB circuit)

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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hemoadsorber for removal of cytokines

Use of the hemoadsorber during cardiac surgery with CPB. Hemoadsorber is integrated into the CPB circuit according to manufacturer's recommendation.

Intervention Type DEVICE

Other Intervention Names

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CytoSorb(R)

Eligibility Criteria

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Inclusion Criteria

* patients with infective endocarditis (according to DUKE criteria) undergoing cardiac surgery
* informed consent
* age ≥18 years

Exclusion Criteria

* EuroScoreII ≤ 3
* current participation in another interventional Trial
* pregnancy
* current immunosuppressive or immunomodulatory therapy (with dosing of glucocorticoids over Cushing threshold)
* previous participation in the REMOVE study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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CytoSorbents, Inc

INDUSTRY

Sponsor Role collaborator

Thermo Fisher Scientific, Inc

INDUSTRY

Sponsor Role collaborator

Fraunhofer Institute for Interfacial Engineering and Biotechnology

OTHER

Sponsor Role collaborator

German Federal Ministry of Education and Research

OTHER_GOV

Sponsor Role collaborator

Jena University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mahmoud Diab, Dr.

Role: STUDY_DIRECTOR

Jena University Hospital, Department of Cardiac and Thoracic Surgery

Locations

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University Heart Center Bad Krozingen

Bad Krozingen, Baden-Wurttemberg, Germany

Site Status

University Heart Center Freiburg

Freiburg im Breisgau, Baden-Wurttemberg, Germany

Site Status

University Hospital Ulm, Clinics of Heart-, Thoracic and Cardiovascular Surgery

Ulm, Baden-Wurttemberg, Germany

Site Status

University Hospital Cologne, Clinic and Policlinics for Heart and Thoracic Surgery

Cologne, North Rhine-Westphalia, Germany

Site Status

University Hospital Essen, Clinic of Thoracic and Cardiovascular Surgery

Essen, North Rhine-Westphalia, Germany

Site Status

Jena University Hospital, Dept. of Cardiac and Thoracic Surgery

Jena, Thuringia, Germany

Site Status

Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie

Bad Oeynhausen, , Germany

Site Status

Herzzentrum Brandenburg, Immanuel Klinikum Bernau

Bernau bei Berlin, , Germany

Site Status

Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Klinik für Herz- und Thoraxchirurgie

Bochum, , Germany

Site Status

Universitätsklinikum Bonn, Klinik und Poliklinik für Herzchirurgie

Bonn, , Germany

Site Status

Herzzentrum Dresden GmbH, Universitätsklinik an der TU Dresden, Klinik für Herzchirurgie

Dresden, , Germany

Site Status

Universitätsklinikum Düsseldorf, Klinik für Kardiovaskuläre Chirurgie

Düsseldorf, , Germany

Site Status

Mitteldeutsches Herzzentrum, Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herzchirurgie

Halle, , Germany

Site Status

Herzzentrum Leipzig, Universitätsklinik für Herzchirurgie

Leipzig, , Germany

Site Status

Countries

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Germany

References

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Bernardi MH, Rinoesl H, Dragosits K, Ristl R, Hoffelner F, Opfermann P, Lamm C, Preissing F, Wiedemann D, Hiesmayr MJ, Spittler A. Effect of hemoadsorption during cardiopulmonary bypass surgery - a blinded, randomized, controlled pilot study using a novel adsorbent. Crit Care. 2016 Apr 9;20:96. doi: 10.1186/s13054-016-1270-0.

Reference Type BACKGROUND
PMID: 27059056 (View on PubMed)

Brunkhorst FM, Oppert M, Marx G, Bloos F, Ludewig K, Putensen C, Nierhaus A, Jaschinski U, Meier-Hellmann A, Weyland A, Grundling M, Moerer O, Riessen R, Seibel A, Ragaller M, Buchler MW, John S, Bach F, Spies C, Reill L, Fritz H, Kiehntopf M, Kuhnt E, Bogatsch H, Engel C, Loeffler M, Kollef MH, Reinhart K, Welte T; German Study Group Competence Network Sepsis (SepNet). Effect of empirical treatment with moxifloxacin and meropenem vs meropenem on sepsis-related organ dysfunction in patients with severe sepsis: a randomized trial. JAMA. 2012 Jun 13;307(22):2390-9. doi: 10.1001/jama.2012.5833.

Reference Type BACKGROUND
PMID: 22692171 (View on PubMed)

Bustamante J, Arevalo A, Tamayo E, Sarria C, Aguilar-Blanco EM, Heredia M, Almansa R, Rico L, Iglesias V, Bermejo-Martin JF. Cytokine profiles linked to fatal outcome in infective prosthetic valve endocarditis. APMIS. 2014 Jun;122(6):526-9. doi: 10.1111/apm.12189. Epub 2013 Sep 30.

Reference Type BACKGROUND
PMID: 24106887 (View on PubMed)

Boyle EM Jr, Pohlman TH, Johnson MC, Verrier ED. Endothelial cell injury in cardiovascular surgery: the systemic inflammatory response. Ann Thorac Surg. 1997 Jan;63(1):277-84. doi: 10.1016/s0003-4975(96)01061-2.

Reference Type BACKGROUND
PMID: 8993292 (View on PubMed)

Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003 Jan 9;348(2):138-50. doi: 10.1056/NEJMra021333. No abstract available.

Reference Type BACKGROUND
PMID: 12519925 (View on PubMed)

Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: A systematic review. Crit Care. 2008;12(6):R161. doi: 10.1186/cc7160. Epub 2008 Dec 17.

Reference Type BACKGROUND
PMID: 19091120 (View on PubMed)

Prendergast BD, Tornos P. Surgery for infective endocarditis: who and when? Circulation. 2010 Mar 9;121(9):1141-52. doi: 10.1161/CIRCULATIONAHA.108.773598. No abstract available.

Reference Type BACKGROUND
PMID: 20212293 (View on PubMed)

Diab M, Lehmann T, Bothe W, Akhyari P, Platzer S, Wendt D, Deppe AC, Strauch J, Hagel S, Gunther A, Faerber G, Sponholz C, Franz M, Scherag A, Velichkov I, Silaschi M, Fassl J, Hofmann B, Lehmann S, Schramm R, Fritz G, Szabo G, Wahlers T, Matschke K, Lichtenberg A, Pletz MW, Gummert JF, Beyersdorf F, Hagl C, Borger MA, Bauer M, Brunkhorst FM, Doenst T; REMOVE Trial Investigators*. Cytokine Hemoadsorption During Cardiac Surgery Versus Standard Surgical Care for Infective Endocarditis (REMOVE): Results From a Multicenter Randomized Controlled Trial. Circulation. 2022 Mar 29;145(13):959-968. doi: 10.1161/CIRCULATIONAHA.121.056940. Epub 2022 Feb 25.

Reference Type RESULT
PMID: 35213213 (View on PubMed)

Diab M, Platzer S, Guenther A, Sponholz C, Scherag A, Lehmann T, Velichkov I, Hagel S, Bauer M, Brunkhorst FM, Doenst T. Assessing efficacy of CytoSorb haemoadsorber for prevention of organ dysfunction in cardiac surgery patients with infective endocarditis: REMOVE-protocol for randomised controlled trial. BMJ Open. 2020 Mar 30;10(3):e031912. doi: 10.1136/bmjopen-2019-031912.

Reference Type DERIVED
PMID: 32234739 (View on PubMed)

Other Identifiers

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ZKSJ0108

Identifier Type: -

Identifier Source: org_study_id

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