Peri-operative Assessment of Coagulopathy in Neonates and Infants Undergoing Cardiac Surgery

NCT02352662 | Withdrawn

• 1 other identifier: IRB-P00016002
• Study Type: observational
• Target: N/A
• Locations: 1 country
• Sites: 1

Brief Summary

This prospective study will aim to globally assess the coagulopathy induced during cardiac surgery with cardiopulmonary bypass (CPB) in a large pediatric population. The investigators primary objective will be the understanding of CPB-induced coagulopathy based on demographic and surgical characteristics, and coagulation assays. Secondary objective will aim at determining the relationship between coagulation assays, postoperative blood loss, and transfusion requirements. The ultimate goal will be to design an algorithm using point-of-care monitoring that could be used to guide hemostatic therapies in neonates and children undergoing cardiac surgery.To do this, investigators will examine the coagulation in the laboratory based setting.

Conditions

Congenital Heart Disease

Keywords

Congenital Heart Disease; Point-of-care coagulation monitoring; Rotaional Thromboelastometry

Outcome Measures

Primary Outcomes (1)

• Evidence of CPB-induced coagulopathy confirmed by coagulation assays

  Over 6 months

Study Arms (1)

Study Group

Three blood samples will be collected intra-operatively from each subject enrolled

Other: Perioperative blood samples collection

Interventions

Perioperative blood samples collection OTHER

Collect blood samples at 3 different points intra-operatively. Each blood sample will be run using rotational thromboelastometry to assess intraoperative coagulation

Study Group

Eligibility Criteria

• Age: Up to 12 Months
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)
• Sampling Method: Non-Probability Sample

Study Population

Neonates and infants undergoing cardiac surgery with cardiopulmonary bypass

You may qualify if:

• Neonates weighing greater than 2.5 kg
• Patients equal to or less than 12 months of age
• Undergoing elective cardiac surgery with cardiopulmonary bypass

You may not qualify if:

• Emergent procedure
• The patient is deemed to be in a moribund condition (American Society of Anesthesiology (ASA 5))

Sponsors & Collaborators

• Boston Children's Hospital: lead

Study Sites (1)

Boston Children's Hospital

Boston, Massachusetts, 02115, United States

Location

Related Publications (13)

• Miller BE, Mochizuki T, Levy JH, Bailey JM, Tosone SR, Tam VK, Kanter KR. Predicting and treating coagulopathies after cardiopulmonary bypass in children. Anesth Analg. 1997 Dec;85(6):1196-202. doi: 10.1097/00000539-199712000-00003.

  PMID: 9390579 BACKGROUND

• Faraoni D, Willems A, Romlin BS, Belisle S, Van der Linden P. Development of a specific algorithm to guide haemostatic therapy in children undergoing cardiac surgery: a single-centre retrospective study. Eur J Anaesthesiol. 2015 May;32(5):320-9. doi: 10.1097/EJA.0000000000000179.

  PMID: 25387300 BACKGROUND

• Paparella D, Brister SJ, Buchanan MR. Coagulation disorders of cardiopulmonary bypass: a review. Intensive Care Med. 2004 Oct;30(10):1873-81. doi: 10.1007/s00134-004-2388-0. Epub 2004 Jul 24.

  PMID: 15278267 BACKGROUND

• Arnold P. Treatment and monitoring of coagulation abnormalities in children undergoing heart surgery. Paediatr Anaesth. 2011 May;21(5):494-503. doi: 10.1111/j.1460-9592.2010.03461.x. Epub 2010 Dec 1.

  PMID: 21118327 BACKGROUND

• Osthaus WA, Boethig D, Johanning K, Rahe-Meyer N, Theilmeier G, Breymann T, Suempelmann R. Whole blood coagulation measured by modified thrombelastography (ROTEM) is impaired in infants with congenital heart diseases. Blood Coagul Fibrinolysis. 2008 Apr;19(3):220-5. doi: 10.1097/MBC.0b013e3282f54532.

  PMID: 18388502 BACKGROUND

• Faraoni D, Savan V, Levy JH, Theusinger OM. Goal-directed coagulation management in the perioperative period of cardiac surgery. J Cardiothorac Vasc Anesth. 2013 Dec;27(6):1347-54. doi: 10.1053/j.jvca.2013.08.005. Epub 2013 Oct 5. No abstract available.

  PMID: 24103717 BACKGROUND

• Gorlinger K, Dirkmann D, Hanke AA, Kamler M, Kottenberg E, Thielmann M, Jakob H, Peters J. First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology. 2011 Dec;115(6):1179-91. doi: 10.1097/ALN.0b013e31823497dd.

  PMID: 21970887 BACKGROUND

• Williams GD, Bratton SL, Ramamoorthy C. Factors associated with blood loss and blood product transfusions: a multivariate analysis in children after open-heart surgery. Anesth Analg. 1999 Jul;89(1):57-64. doi: 10.1097/00000539-199907000-00011.

  PMID: 10389779 BACKGROUND

• Hayashi T, Sakurai Y, Fukuda K, Yada K, Ogiwara K, Matsumoto T, Yoshizawa H, Takahashi Y, Yoshikawa Y, Hayata Y, Taniguchi S, Shima M. Correlations between global clotting function tests, duration of operation, and postoperative chest tube drainage in pediatric cardiac surgery. Paediatr Anaesth. 2011 Aug;21(8):865-71. doi: 10.1111/j.1460-9592.2011.03524.x. Epub 2011 Jan 21.

  PMID: 21251146 BACKGROUND

• Jensen AS, Johansson PI, Bochsen L, Idorn L, Sorensen KE, Thilen U, Nagy E, Furenas E, Sondergaard L. Fibrinogen function is impaired in whole blood from patients with cyanotic congenital heart disease. Int J Cardiol. 2013 Sep 1;167(5):2210-4. doi: 10.1016/j.ijcard.2012.06.019. Epub 2012 Jun 22.

  PMID: 22727966 BACKGROUND

• Faraoni D, Willems A, Savan V, Demanet H, De Ville A, Van der Linden P. Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery. A retrospective review. Eur J Anaesthesiol. 2014 Jun;31(6):317-26. doi: 10.1097/EJA.0000000000000043.

  PMID: 24503704 BACKGROUND

• Faraoni D, Van der Linden P. Factors affecting postoperative blood loss in children undergoing cardiac surgery. J Cardiothorac Surg. 2014 Feb 11;9:32. doi: 10.1186/1749-8090-9-32.

  PMID: 24512988 BACKGROUND

• Lacroix J, Hebert PC, Hutchison JS, Hume HA, Tucci M, Ducruet T, Gauvin F, Collet JP, Toledano BJ, Robillard P, Joffe A, Biarent D, Meert K, Peters MJ; TRIPICU Investigators; Canadian Critical Care Trials Group; Pediatric Acute Lung Injury and Sepsis Investigators Network. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007 Apr 19;356(16):1609-19. doi: 10.1056/NEJMoa066240.

  PMID: 17442904 BACKGROUND

Biospecimen

Retention: SAMPLES WITHOUT DNA

Collect bloods samples at three different time points intraoperatively to look at coagulation factors

MeSH Terms

Conditions

Heart Defects, Congenital

Condition Hierarchy (Ancestors)

Cardiovascular Abnormalities; Cardiovascular Diseases; Heart Diseases; Congenital Abnormalities; Congenital, Hereditary, and Neonatal Diseases and Abnormalities

Study Officials

• David Faraoni, MD

  Boston Children's Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Cardiac Anesthesiologist

Study Record Dates

• First Submitted: January 26, 2015
• First Posted: February 2, 2015
• Study Start: April 1, 2015
• Primary Completion: April 1, 2017
• Study Completion: April 1, 2017
• Last Updated: April 10, 2017

Record last verified: 2017-04

Locations

US (1)