Canadian-American Spinal Cord Perfusion Pressure and Biomarker Study

NCT ID: NCT03911492

Last Updated: 2023-07-03

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

RECRUITING

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-08-31

Study Completion Date

2025-12-31

Brief Summary

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This multicenter study will enroll 100 patients with acute traumatic cervical and thoracic SCI who have a lumbar intrathecal catheter inserted within 24 hours of their injury. The lumbar intrathecal catheter will be inserted pre-operatively for the measurement of ITP and the collection of cerebrospinal fluid (CSF) samples. SCPP will be calculated as the difference between MAP and the ITP.

There are two important distinct yet related objectives in this prospective interventional study.

1. Determine the effect of SCPP maintenance ≥ 65 mmHg in acute SCI on neurologic recovery as measured by ASIA Impairment Scale (AIS) grade conversion and motor score improvement.
2. Collect CSF and blood samples for the measurement of neurochemical biomarkers and storage for future biomarker discovery and validation studies.

Detailed Description

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Objective 1. To determine if actively maintaining an SCPP of at least 65 mmHg with a combination of MAP augmentation and CSF drainage promotes better neurologic recovery than routine hemodynamic management that focuses solely on MAP augmentation.

Objective 2. To determine if actively maintaining an SCPP of at least 65 mmHg with a combination of MAP augmentation and CSF drainage will allow for a reduction in the usage of vasopressors in acute SCI.

Objective 3. To determine the feasibility of draining CSF to reduce ITP in the acute post-injury setting, when the cord may be swollen against the dura causing subarachnoid space occlusion at the injury site.

Objective 4. To determine if there are complications associated with the installation of the intrathecal catheter and drainage of CSF in the acute SCI patient.

Conditions

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Acute Spinal Cord Injury Acute Spinal Paralysis Spinal Cord Injuries SPINAL Fracture

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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SCP Pressure Management

Active management of Spinal Cord Perfusion Pressure (SCPP) at or above 65 mmHg.

Group Type OTHER

SCPP Management => 65 mmHg

Intervention Type PROCEDURE

A lumbar intrathecal catheter will be inserted pre-operatively for the measurement of Intrathecal pressure (ITP) and the collection of cerebrospinal fluid (CSF) samples. SCPP will be calculated as the difference between Mean Arterial Pressure (MAP) and the ITP.

Interventions

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SCPP Management => 65 mmHg

A lumbar intrathecal catheter will be inserted pre-operatively for the measurement of Intrathecal pressure (ITP) and the collection of cerebrospinal fluid (CSF) samples. SCPP will be calculated as the difference between Mean Arterial Pressure (MAP) and the ITP.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Male or Female ≥ 17 (or the provincial age of majority - depending on local REB guidelines)
* Complete (AIS A) or incomplete (AIS B, C) acute traumatic spinal cord injury.
* Bony spinal levels between C0 and T12 inclusive.
* Blunt (non-penetrating) spinal cord injury treated either surgically or non-surgically
* Lumbar intrathecal catheter to be inserted as part of clinical hemodynamic management and CSF sample collected within 48 hours of injury
* Initial blood sample collected within 24 hours of injury

Exclusion Criteria

* Motor incomplete spinal cord injury AIS D (i.e. at least half (half or more) of the key muscle functions below the neurological level of injury (NLI) have a muscle grade greater than or equal to 3/5)
* Spinal cord injury with sensory deficit only (i.e. no motor deficit)
* Penetrating spinal cord injury (including gunshot wounds)
* Isolated radiculopathy
* Isolated cauda equina injury or spinal injury below L1
* Associated injury (soft tissue or bony) to the lumbar spine where the intrathecal catheter would be placed
* Associated traumatic conditions that would interfere with the outcome assessment (e.g., traumatic brain injury, chest, pelvis, abdomen, or femur injury requiring operative intervention)
* Pre-existing neurodegenerative disorder, such as Parkinson's disease, Alzheimer's disease, Huntington's disease, multiple sclerosis, amyotrophic lateral sclerosis
* Pre-existing thromboembolic disease or coagulopathy, such as hemophilia, von Willebrand disease
* Presence of systemic disease that might interfere with patient safety, compliance or evaluation of the condition under study (e.g., clinically significant cardiac disease, HIV, Hep B or C) HTLV-1
* Pre-existing inflammatory or autoimmune disorder (e.g. rheumatoid arthritis, systemic lupus, psoriasis, or ankylosing spondylitis
* Any other medical condition that in the investigator's opinion would render the protocol procedures dangerous or impair the ability of the patient to receive protocol therapy
* Female patients who are pregnant
Minimum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rick Hansen Institute

OTHER

Sponsor Role collaborator

University of British Columbia

OTHER

Sponsor Role lead

Responsible Party

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Brian Kwon

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Brian Kwon, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of British Columbia, Faculty of Medicine

Locations

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Zuckerberg San Francisco General Hospital and Trauma Center

San Francisco, California, United States

Site Status RECRUITING

University of Nebraska Medical Center

Omaha, Nebraska, United States

Site Status RECRUITING

University of New Mexico Health Sciences Center

Albuquerque, New Mexico, United States

Site Status RECRUITING

University Pittsburgh Medical Center

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status RECRUITING

Halifax Infirmary - QEII

Halifax, Nova Scotia, Canada

Site Status RECRUITING

St. Michael's Hospital

Toronto, Ontario, Canada

Site Status RECRUITING

Hopital Du Sacre-Coeur de Montreal

Montreal, Quebec, Canada

Site Status RECRUITING

Countries

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United States Canada

Central Contacts

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Allan Aludino

Role: CONTACT

604-875-4111 ext. 61689

Facility Contacts

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Xuan Duong Fernandez

Role: primary

Dulce Maroni

Role: primary

Amal Alchbli

Role: primary

Allan Aludino, Research Program Manager

Role: primary

1-604-875-4111 ext. 61689

Cecilia He

Role: primary

Pascal Mputu

Role: primary

Other Identifiers

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H19-00805

Identifier Type: -

Identifier Source: org_study_id

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