Fibrinogen Early In Severe Trauma studY Junior

NCT ID: NCT03508141

Last Updated: 2020-06-29

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

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

44 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-07-01

Study Completion Date

2021-06-30

Brief Summary

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1. Haemorrhage in severe trauma is a significant cause of mortality and is potentially the most preventable cause of death in paediatric trauma patients
2. Trauma Induced Coagulopathy (TIC) is a complex coagulopathy associated with severe trauma
3. Hypo/dysfibrinogenaemia plays an important role in TIC
4. Early replacement of fibrinogen may improve outcomes
5. Fibrinogen replacement is potentially inadequate in standard fixed ratio Major Haemorrhage Protocols (MHP) utilising Plasma and/or Cryoprecipitate
6. The majority of centres utilise cryoprecipitate for additional fibrinogen supplementation as part of a MHP
7. Cryoprecipitate administration is often delayed (between 60 - 120 minutes) in a fixed ratio MHP
8. It is clear early intervention in severe traumatic haemorrhage is associated with improved outcomes - CRASH 2 and PROPPR studies
9. Increasing interest in the use of Fibrinogen Concentrate (FC) in severe bleeding but not supported by high level evidence
10. Benefits of FC - viral inactivation, known dose, easily reconstituted, can be administered quickly in high dose and stored at room temperature in the trauma resuscitation bay

12\. No previous studies comparing FC and Cryoprecipitate in bleeding paediatric trauma patients 13. Fibrinogen supplementation will be guided by an accepted ROTEM targeted treatment algorithm 14. Pilot, multi-centre randomised controlled trial comparing FC to Cryoprecipitate (current standard practise in fibrinogen supplementation) 15. Hypothesis: Fibrinogen replacement in severe traumatic haemorrhage can be achieved quicker with a more predictable dose response using Fibrinogen Concentrate compared to Cryoprecipitate 16. It is imperative that robust and clinically relevant trials are performed to investigate fibrinogen supplementation in paediatric trauma patients before widespread adoption makes performing such studies unfeasible

Detailed Description

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Conditions

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Trauma Hemorrhage Coagulopathy Pediatrics

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Fibrinogen Concentrate

Fibrinogen Replacement using Fibrinogen Concentrate as per ROTEM (FIBTEM) FIBTEM A5 0mm = 60mg/kg FC FIBTEM A5 1-4mm = 50mg/kg FC FIBTEM A5 5-6mm = 40mg/kg FC FIBTEM A5 7-8mm = 30mg/kg FC FIBTEM A5 9-10mm = 20mg/kg FC

Group Type EXPERIMENTAL

Fibrinogen Concentrate

Intervention Type DRUG

Experimental

Cryoprecipitate

Fibrinogen Replacement using Cryoprecipitate as per ROTEM (FIBTEM) FIBTEM A5 0mm = 6ml/kg Cryoprecipitate FIBTEM A5 1-4mm = 5ml/kg Cryoprecipitate FIBTEM A5 5-6mm = 4ml/kg Cryoprecipitate FIBTEM A5 7-8mm = 3ml/kg Cryoprecipitate FIBTEM A5 9-10mm = 2ml/kg Cryoprecipitate

Group Type ACTIVE_COMPARATOR

Cryoprecipitate

Intervention Type DRUG

Comparator

Interventions

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Fibrinogen Concentrate

Experimental

Intervention Type DRUG

Cryoprecipitate

Comparator

Intervention Type DRUG

Other Intervention Names

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Riastap

Eligibility Criteria

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Inclusion Criteria

1. Child affected by trauma (3 months to 18 years)
2. Judged to have significant haemorrhage OR predicted to require significant transfusion by the treating clinician
3. Activation of Local MHP or transfusion of emergency red blood cells (Pre-hospital or at Trauma Centre)

Exclusion Criteria

1. Injury judged incompatible with survival
2. Randomisation unable to occur within 6 hours of hospital admission
3. Pregnancy
4. Known personal or parental objection to blood products
5. Known coagulation disorder (i.e. haemophilia, von Willebrand disease)
6. Previous dedicated fibrinogen replacement this admission
7. Pre-Trauma Centre dedicated fibrinogen replacement
8. Participation in competing study
Minimum Eligible Age

3 Months

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Emergency Medicine Foundation

OTHER

Sponsor Role collaborator

National Blood Authority

OTHER

Sponsor Role collaborator

Australian Red Cross

OTHER

Sponsor Role collaborator

Gold Coast Hospital and Health Service

OTHER_GOV

Sponsor Role lead

Responsible Party

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Dr James Winearls, BSc (Hons), MBBS, MRCP, FCICM

Dr James Winearls, Consultant Intensivist GCUH

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Shane George, MBBS

Role: PRINCIPAL_INVESTIGATOR

Lady Cilento Children's Hospital

Locations

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Westmead Childrens Hospital

Sydney, New South Wales, Australia

Site Status RECRUITING

Royal Brisbane and Women's Hospital

Brisbane, Queensland, Australia

Site Status RECRUITING

Lady Cilento Children's Hospital

Brisbane, Queensland, Australia

Site Status RECRUITING

Princess Alexandra Hospital

Brisbane, Queensland, Australia

Site Status RECRUITING

Cairns Hospital

Cairns, Queensland, Australia

Site Status RECRUITING

Gold Coast University Hospital

Gold Coast, Queensland, Australia

Site Status RECRUITING

Mackay Base Hospital

Mackay, Queensland, Australia

Site Status RECRUITING

Rockhampton Hospital

Rockhampton, Queensland, Australia

Site Status RECRUITING

Townsville Hospital

Townsville, Queensland, Australia

Site Status RECRUITING

Royal Adelaide Hospital

Adelaide, South Australia, Australia

Site Status RECRUITING

Countries

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Australia

Central Contacts

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James Winearls, MBBS

Role: CONTACT

+61756875684

Elizabeth Wake, BN

Role: CONTACT

+61756874149

Facility Contacts

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Melanie Jansen

Role: primary

Cath Hurn, MBBS

Role: primary

Dr George, MBBS

Role: primary

Glenn Ryan, MBBS

Role: primary

Cath Tacon, FCICM

Role: primary

James Winearls, MBBS

Role: primary

Anni Paasilahti, FCICM

Role: primary

Helen Miles, MBBS

Role: primary

Melita Trout, MBBS

Role: primary

Daniel Ellis, MBBS, FACEM, FCICM, FIMC

Role: primary

References

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George S, Wake E, Jansen M, Roy J, Maconachie S, Paasilahti A, Wiseman G, Gibbons K, Winearls J; FEISTY Investigators. Fibrinogen Early In Severe paediatric Trauma studY (FEISTY junior): protocol for a randomised controlled trial. BMJ Open. 2022 May 4;12(5):e057780. doi: 10.1136/bmjopen-2021-057780.

Reference Type DERIVED
PMID: 35508351 (View on PubMed)

Other Identifiers

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FEISTY Jnr 1

Identifier Type: -

Identifier Source: org_study_id

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