Active Clearance Technology (ACT) II German Multicenter Trial

Sponsor

Prof. Dr. Theodor Fischlein (Other)

Overall Status

Unknown status

CT.gov ID

NCT02479737

Collaborator

ClearFlow, Inc. (Industry)

1,113

Enrollment

Locations

Duration (Months)

556.5

Patients Per Site

27.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Postoperative bleeding is a common consequence after heart surgery which can significantly impact outcomes and costs [Wynne R, Christensen MC, Dixon B]. When bleeding occurs, reliable postoperative blood evacuation of the pleural, mediastinal and pericardial spaces with chest tubes is imperative to facilitate pulmonary re-expansion and mediastinal decompression as the patient recovers. When postoperative blood evacuation is inadequate, retained blood complications can result (herein described as the Retained Blood Complications (RBC). RBC is the presence of post-operative pericardial and/or pleural fluid or blood that is diagnosed and may necessitate drainage in the acute or sub-acute setting. The need for treatment and interventions for these conditions represents an impediment to patient recovery and involves both resource and economic consumption for a heart program and the healthcare system at large.

Clinically, Retained Blood Complications (RBC) can be recognized acutely or subacutely. When it presents acutely, it is usually fresh thrombus around the heart or lungs presenting as tamponade or hemothorax. When it presents subacutely, it results in bloody pleural or pericardial effusions. These effusions are often driven by the breakdown of remaining thrombus. Once RBC occurs, subsequent procedures may be needed to remedy it.

A recent review of the literature indicated that additional procedures for RBC are demonstrated in approximately 15% to 20% of patients after heart surgery. In a prospectively collected United States Nationwide Inpatient Sample (NIS) data from 2010, RBC could be demonstrated in 17% of patients. In this analysis, mortality was doubled from 4% to 8%, length of stay was increased by 5 days, and average costs were 55% higher. Patients with RBC, therefore, represent an increased at risk population for complications and costs.

Postoperative obstruction of conventional chest tubes with blood and other fibrinous material in the setting of postoperative bleeding contributes to RBC. (Shalli) In a recent study of postoperative cardiac surgery patients at the Cleveland Clinic, 36% of patients were found to have evidence of chest tube obstruction . Active Clearance with PleuraFlow has been shown to prevent chest tube clogging, and reduce RBC.

Condition or Disease	Intervention/Treatment	Phase
Heart Surgery	Device: Blood drainage post cardiac surgery using PleuraFlow System

Detailed Description

Complications from RBS are defined as those requiring re-operation or surgical interventions to evacuate blood, blood clot, bloody fluid, and air accumulation within the operative site after closure of the surgical wound. This is a prospective multicenter observational post-market study with a retrospective component. The study is open to up to five (5) German sites enrolling a consecutive cohort of cardiac surgery patients.

There are two conditions for participation in this registry. First, sites are required to enter into the study database anonymized matched historical data elements from a cohort of cardiac surgery patients done over the preceding 12 to 24-month period (Phase 0). These retrospective data elements will be used as baseline information for the purpose of comparative analyses with the prospective data sets. Second, sites that have not been using the PleuraFlow System before enrolling patients to this study are required to participate in a roll-in phase (Phase 1). The purposes of the roll-in phase are to allow the users at participating sites to familiarize themselves with the product use and with ACT, to implement Clinical Use Protocols provided by ClearFlow, Inc. to all commercial users as part of product training, and to demonstrate consistency and compliance with the clinical use protocols.

Study Design

Study Type:

Observational [Patient Registry]

Anticipated Enrollment :

1113 participants

Observational Model:

Cohort

Time Perspective:

Prospective

Official Title:

The Active Clearance Technology (ACT) II German Multicenter Trial

Study Start Date :

Apr 1, 2016

Anticipated Primary Completion Date :

Jul 1, 2017

Anticipated Study Completion Date :

Dec 1, 2017

Outcome Measures

Primary Outcome Measures

Percent reduction in the rate of interventions to treat Retained Blood Syndrome (RBS) [participants will be followed for the duration of hospital stay, an expected average of 12 days]
RBS is a composite endpoint defined as an intervention to treat one or more of the following conditions: -Re-exploration for bleeding, tamponade or washout of retained bloo

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Male or Female subjects 18 years or older who received a PleuraFlow System following heart surgery

Exclusion Criteria:

Any condition deemed inappropriate for inclusion by the investigators
Infants, children and adolescents under the age of 18

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Herz- und Gefäßklinik GmbH	Bad Neustadt an der Saale	Bavaria	Germany	97616
2	Paracelsus Medical University, Klinikum, Nuremberg, Germany	Nuremberg	Bavaria	Germany	90471