Influence of Oxygenator Selection on Platelet Function and Rotational Thromboelastometry Following Cardiopulmonary Bypass

NCT ID: NCT05588011

Last Updated: 2025-04-02

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

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-10-07

Study Completion Date

2025-07-31

Brief Summary

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Open-heart surgery requires temporarily stopping the heart and lungs and diverting the patient's blood to an outside system that takes over the function of the heart and lungs. This is possible through the use of cardiopulmonary bypass (CPB) which diverts blood, through plastic tubing, to a heart-lung machine which includes an oxygenator. The external oxygenator works as an artificial lung. This allows cardiac surgeons to operate in a field that is free of blood, while the patient's body continues to receive healthy blood.

CPB is an advanced medical technology that allows for heart surgeries, such as coronary artery bypass, heart valve surgery, and procedures involving major blood vessels. It is recognized that there are many risks associated with its use, including microscopic stress exerted on blood components by the oxygenator and tubing, which can lead to irreversible damage to the blood cells. This effect can contribute to bleeding during and after surgery. This type of bleeding can be difficult to monitor and treat, especially given the limited access to point-of-care blood testing to inform clinicians on what part of the blood is failing to function properly.

The investigators will use a point-of-care machine called Plateletworks to test the function of platelets during surgeries which require CPB. Platelets are an important part of blood that help stop bleeding by forming clots. At the investigators' institution two oxygenators are currently used interchangeably. These oxygenators have different properties that may impact how platelets function. This project will help determine if using a higher pressure oxygenator increases the risk of patients bleeding. Additionally, the investigators will compare the platelet data from Plateletworks to data collected from rotational thromboelastometry (ROTEM). This will yield valuable data about commonly used oxygenators and tests which can ultimately improve patient care.

Detailed Description

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Conditions

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Platelet Dysfunction Cardiopulmonary Bypass

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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LivaNova Inspire

A high pressure oxygenator (LivaNova) will be used during cardiopulmonary bypass.

Group Type ACTIVE_COMPARATOR

LivaNova

Intervention Type DEVICE

A high pressure oxygenator (LivaNova) will be used during cardiopulmonary bypass.

Terumo

A low pressure oxygenator (Terumo) will be used during cardiopulmonary bypass.

Group Type ACTIVE_COMPARATOR

Terumo

Intervention Type DEVICE

A low pressure oxygenator (Terumo) will be used during cardiopulmonary bypass.

Interventions

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Terumo

A low pressure oxygenator (Terumo) will be used during cardiopulmonary bypass.

Intervention Type DEVICE

LivaNova

A high pressure oxygenator (LivaNova) will be used during cardiopulmonary bypass.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Scheduled for non emergent cardiac surgery
* Anticipated long CPB time (Multi-vessel CABG, multi-valve surgeries, or combined CABG and valve procedures)

Exclusion Criteria

* Pregnancy
* Age under 18 years on the surgery date
* Weight less than 60kg
* Any known pre-existing bleeding disorder
* Inability to provide informed consent
* Pre-existing abnormal fibrinogen level (normal: 1.8-4.7g/l)
* Significant liver disease (alanine aminotransferase or aspartate aminotransferase \> 150 U/l)
* INR \> 1.4
* PTT greater than 38 (off IV heparin for 12h prior to testing)
* Direct oral anticoagulant (DOAC) use within 72h preoperatively
* Significant renal disease (eGFR \< 50)
* Emergency surgery
* Intake of anti-platelet drugs (including ticagrelor and Plavix but excluding ASA) within three days (72h) preoperatively
* Anemia (Hb \< 110)
* Deep vein thrombosis (DVT) (within 3 months prior to OR)
* Pulmonary embolism (within 3 months prior to OR)
* Stroke (within 3 months prior to OR)
* Planned hypothermia below 28 degrees Celsius.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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BRADEN DULONG

OTHER

Sponsor Role lead

Responsible Party

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BRADEN DULONG

Anesthesiologist

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Braden Dulong, MD

Role: PRINCIPAL_INVESTIGATOR

Nova Scotia Health

Locations

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Halifax Infirmary site, Queen Elizabeth II Health Sciences Centre

Halifax, Nova Scotia, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Braden Dulong, MD

Role: CONTACT

19024732331

Taryn Forrestall

Role: CONTACT

19029439330

Facility Contacts

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Taryn Forrestall

Role: primary

19029439330

References

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Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA); Boer C, Meesters MI, Milojevic M, Benedetto U, Bolliger D, von Heymann C, Jeppsson A, Koster A, Osnabrugge RL, Ranucci M, Ravn HB, Vonk ABA, Wahba A, Pagano D. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):88-120. doi: 10.1053/j.jvca.2017.06.026. Epub 2017 Sep 30. No abstract available.

Reference Type BACKGROUND
PMID: 29029990 (View on PubMed)

Despotis G, Eby C, Lublin DM. A review of transfusion risks and optimal management of perioperative bleeding with cardiac surgery. Transfusion. 2008 Mar;48(1 Suppl):2S-30S. doi: 10.1111/j.1537-2995.2007.01573.x. No abstract available.

Reference Type BACKGROUND
PMID: 18302579 (View on PubMed)

Hardwick RA, Hellums JD, Peterson DM, Moake JL, Olson JD. The effect of PGI2 and theophylline on the response of platelets subjected to shear stress. Blood. 1981 Oct;58(4):678-81.

Reference Type BACKGROUND
PMID: 7023570 (View on PubMed)

Karkouti K, McCluskey SA, Callum J, Freedman J, Selby R, Timoumi T, Roy D, Rao V. Evaluation of a novel transfusion algorithm employing point-of-care coagulation assays in cardiac surgery: a retrospective cohort study with interrupted time-series analysis. Anesthesiology. 2015 Mar;122(3):560-70. doi: 10.1097/ALN.0000000000000556.

Reference Type BACKGROUND
PMID: 25485470 (View on PubMed)

Karkouti K, Callum J, Wijeysundera DN, Rao V, Crowther M, Grocott HP, Pinto R, Scales DC; TACS Investigators. Point-of-Care Hemostatic Testing in Cardiac Surgery: A Stepped-Wedge Clustered Randomized Controlled Trial. Circulation. 2016 Oct 18;134(16):1152-1162. doi: 10.1161/CIRCULATIONAHA.116.023956. Epub 2016 Sep 21.

Reference Type BACKGROUND
PMID: 27654344 (View on PubMed)

Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD, O'Malley BA, Sesok-Pizzini DA, Shander A, Stack GE, Webert KE, Weinstein R, Welch BG, Whitman GJ, Wong EC, Tobian AA; AABB. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2015 Feb 3;162(3):205-13. doi: 10.7326/M14-1589.

Reference Type BACKGROUND
PMID: 25383671 (View on PubMed)

Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ, Blackstone EH. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg. 2006 May;81(5):1650-7. doi: 10.1016/j.athoracsur.2005.12.037.

Reference Type BACKGROUND
PMID: 16631651 (View on PubMed)

Kwapisz MM, Kent B, DiQuinzio C, LeGare JF, Garnett S, Swyer W, Whynot S, Mingo H, Scheffler M. The prophylactic use of fibrinogen concentrate in high-risk cardiac surgery. Acta Anaesthesiol Scand. 2020 May;64(5):602-612. doi: 10.1111/aas.13540. Epub 2020 Jan 17.

Reference Type BACKGROUND
PMID: 31889306 (View on PubMed)

Maquelin KN, Berckmans RJ, Nieuwland R, Schaap MC, ten Have K, Eijsman L, Sturk A. Disappearance of glycoprotein Ib from the platelet surface in pericardial blood during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1998 May;115(5):1160-5. doi: 10.1016/s0022-5223(98)70416-7.

Reference Type BACKGROUND
PMID: 9605086 (View on PubMed)

Transfusion of Red Blood Cells, Fresh Frozen Plasma, or Platelets Is Associated With Mortality and Infection After Cardiac Surgery in a Dose-Dependent Manner. Anesth Analg. 2020 Feb;130(2):e32. doi: 10.1213/ANE.0000000000004528.

Reference Type BACKGROUND
PMID: 31702696 (View on PubMed)

Ranucci M, Baryshnikova E, Castelvecchio S, Pelissero G; Surgical and Clinical Outcome Research (SCORE) Group. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg. 2013 Aug;96(2):478-85. doi: 10.1016/j.athoracsur.2013.03.015. Epub 2013 May 11.

Reference Type BACKGROUND
PMID: 23673069 (View on PubMed)

Raphael J, Mazer CD, Subramani S, Schroeder A, Abdalla M, Ferreira R, Roman PE, Patel N, Welsby I, Greilich PE, Harvey R, Ranucci M, Heller LB, Boer C, Wilkey A, Hill SE, Nuttall GA, Palvadi RR, Patel PA, Wilkey B, Gaitan B, Hill SS, Kwak J, Klick J, Bollen BA, Shore-Lesserson L, Abernathy J, Schwann N, Lau WT. Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients. Anesth Analg. 2019 Nov;129(5):1209-1221. doi: 10.1213/ANE.0000000000004355.

Reference Type BACKGROUND
PMID: 31613811 (View on PubMed)

Stanzel RD, Henderson M. Clinical evaluation of contemporary oxygenators. Perfusion. 2016 Jan;31(1):15-25. doi: 10.1177/0267659115604709. Epub 2015 Sep 25.

Reference Type BACKGROUND
PMID: 26407816 (View on PubMed)

Weerasinghe A, Taylor KM. The platelet in cardiopulmonary bypass. Ann Thorac Surg. 1998 Dec;66(6):2145-52. doi: 10.1016/s0003-4975(98)00749-8.

Reference Type BACKGROUND
PMID: 9930521 (View on PubMed)

Other Identifiers

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NSH REB# 1027560

Identifier Type: -

Identifier Source: org_study_id

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