Acute Heart Failure, Cardiac Arrest With Successful Resuscitation, Cardiogenic Shock, Decompensated Heart Failure, Multiple Organ Failure, Pulmonary Failure, Sepsis, Ventricular Arrythmia
Conditions
Keywords
Anesthesiology, Cardiothoracic surgery, Nephrology, Perfusion, Efferentology
Brief summary
The purpose of the program. Formulation of new treatments for heart and pulmonary failure through using organ-replacing technologies. Formulation of a clinical protocol and implementation of treatment methods into clinical practice heart and pulmonary failure using organ-replacing technologies. New methods were created for rehabilitating the function of affected organs after implantation of the LVAD, a total artificial heart, an extracorporeal life-sustaining system will be of great importance, both for Kazakhstan and for states with similar problems of donor organ deficiency, will also improve the effectiveness of surgical treatment and reduce the level of complications and mortality of patients on the extracorporeal life-sustaining system and septic patients.
Detailed description
Objectives of the program. Task 1. Assessment of the results of the use of extracorporeal life support systems in the treatment of pulmonary and/or heart failure. Subtask 1.1. Assessment of the restoration of organ function during extracorporeal life support systems using extracorporeal hemocorrection. Subtask 1.2. Assessment of the normalization of the body's immune response and restoration of organ function during extracorporeal life support systems using an extracorporeal cytokine adsorber. Task 2. Studying the restoration of organ function during implantation of the left ventricular assist device as an organ-replacing aid in heart failure. Subtask 2.1. Assessment of the restoration of organ function during implantation of the left ventricular assist device with the use of extracorporeal hemocorrection. Subtask 2.2. Assessment of the normalization of the body's immune response and restoration of organ function upon implantation of the left ventricular assist device using an extracorporeal cytokine adsorber. Task 3. Studying the restoration of organ function during the implantation of the total artificial heart as an organ-replacing aid in case of heart failure. Task 3.1. Assessment of normalization of organ function restoration during implantation of the total artificial heart with the use of extracorporeal hemocorrection. Task 4. Studying the restoration of organ function during operations in conditions of the long-term cardiopulmonary bypass. Task 4.1. Assessment of the restoration of organ function during operations with long-term cardiopulmonary bypass, hypothermia, and circulatory arrest, with the use of extra corporeal hemocorrection. Task 4.2. Assessment of the restoration of organ function during operations with long-term cardiopulmonary bypass, hypothermia, and circulatory arrest using an extracorporeal cytokine adsorber. Task 5. Improvement of the method of implantation of organ-replacing technologies to reduce complications in the treatment of heart and pulmonary failure. Study design. Study type: interventional (clinical study) Set of participants: 100 participants Distribution: randomized Interventional model: parallel Masking: no Primary Goal: Treatment
Interventions
DEVICEHA330 - Jafron Biomedical Co., Ltd., China - extracorporeal hemocorrection
HA330 - Jafron Biomedical Co., Ltd., China - extracorporeal hemocorrection, which is based on the removal of cytokines from whole blood by sorption on a special hemoadsorbent due to the peculiarities of its porous structure and inner surface, which is indicated in conditions where cytokine levels are extremely elevated
DEVICECytoSorb (CytoSorbents Corp., USA) - an extracorporeal cytokine adsorber
CytoSorb (CytoSorbents Corp., USA) - an extracorporeal cytokine adsorber is a biocompatible polymer with high adsorption capacity, which is indicated in conditions where cytokine levels are extremely elevated
Sponsors
Ministry of Education and Science, Republic of Kazakhstan
National Research Center for Cardiac Surgery, Kazakhstan
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Intervention team # 1 using an extracorporeal hemoperfusion device Jafron (Zhuhai Jafron Biomedical, China) (50 patients) in subgroups: A (n = 10) - patients on extracorporeal life support systems with heart failure; B (n = 10) - patients on extracorporeal life support systems with pulmonary failure; C (n = 5) - patients with implantation of a left ventricular accessory device; D (n = 25) - during operations with prolonged artificial circulation, hypothermia and circulatory arrest. Intervention team # 2 using extracorporeal cytokine, CytoSorb (CytoSorbents Corporation, Monmouth Junction, NJ, USA) (50 patients) in subgroups: A (n = 10) - patients on extracorporeal life support systems in heart failure; B (n = 10) - patients on extracorporeal life support systems with pulmonary failure; C (n = 5) - patients with implantation of a left ventricular accessory device; D (n = 25) - during operations with prolonged artificial circulation, hypothermia and circulatory arrest.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Patients on an extracorporeal life support system with heart failure: * Implantation of intravenous ECMO * Hemodynamic support with vasopressors and/or tonics; * Procalcitonin level ≥ 1 ng/ml; * Invasive hemodynamic monitoring; * Written informed consent. Patients on an extracorporeal life support system with pulmonary failure: * IV ECMO implantation * High levels of venous and arterial CO2 (CO2\> 50 mmHg), * Low paO2, SvO2, SpO2. * Invasive hemodynamic monitoring; * Written informed consent. -Patients with left ventricular assistive device implantation: * LVAD implantation * Biventricular heart failure IV * INTERMACS I-III * Hemodynamic support with vasopressors and/or tonics; * Procalcitonin level ≥ 0.1 ng/ml; * Invasive hemodynamic monitoring; * Written informed consent. -Patients in operations with prolonged artificial circulation, hypothermia and circulatory arrest: * Hemodynamic support with vasopressors and/or tonics; * Bypass duration\> 120 minutes * Hypothermia ≤ 25 0С * Circulatory arrest * Procalcitonin level ≥ 1 ng/ml; * Invasive hemodynamic monitoring; * Written informed consent.
Exclusion criteria
* Patients on an extracorporeal life support system with heart failure: * Age less than 18 years old * Terminal hepatic or renal failure just before the procedure * Patient's written refusal to participate in the study * Patients on an extracorporeal life support system with pulmonary failure: * Age less than 18 years old * Terminal hepatic or renal failure just before the procedure * Patient's written refusal to participate in the study * Patients with left ventricular assistive device implantation: * Age less than 18 years old * Acute hepatic or renal failure just before the procedure * Patient's written refusal to participate in the study * Patients in operations with prolonged artificial circulation, hypothermia and circulatory arrest: * Age less than 18 years old * Terminal hepatic or renal failure just before the procedure * Patient's written refusal to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| For operations with prolonged artificial circulation, hypothermia and circulatory arrest: Level of Serum lactate | 24, 48, 72 hours | Comparison of mean arterial pressure at 24, 48, 72 hours between between two interventions (CytoSorb and Jafron) |
| For operations with prolonged artificial circulation, hypothermia and circulatory arrest: Difference of mean arterial pressure | 24, 48, 72 hours | Comparison of mean arterial pressure at 24, 48, 72 hours between between two interventions (CytoSorb and Jafron) |
| For operations with prolonged artificial circulation, hypothermia and circulatory arrest: Difference of CVP | 24, 48, 72 hours | Comparison of mean arterial pressure at 24, 48, 72 hours between between two interventions (CytoSorb and Jafron) |
| Extracorporeal life support system with pulmonary and / or heart failure: Cytokine response | 24-48 hours | The level of pro- and anti-inflammatory cytokines (IL-1, IL-6, IL-8, IL-10, tumor alpha-factor) before the start, 2 hours after the start of ECMO support, when ECMO is turned off, 24 hours after ECMO is turned off. |
| Extracorporeal life support system with pulmonary and / or heart failure: SOFA-Score | 24, 48, 72 hours | Sequential Organ Failure Assessment Score at 24, 48, 72 h (values from 6 to 24, where the higher values explain higher disease severity) |
| Extracorporeal life support system with pulmonary and / or heart failure | Time: first 72 hours | Doses of vasopressors and / or inotropes (µg / h / kg bodyweight) |
| Patients with left ventricular assist device implantation: Difference of Cytokine response | 24-48 hours | Level of pro- and anti-inflammatory cytokines (IL-1, IL-6, IL-8, IL-10, tumor necrosis factor-alfa, procalcitonin) |
| Patients with left ventricular assist device implantation:vasopressors and / or inotropes | first 72 hours | Doses of vasopressors and / or inotropes (µg / h / kg bodyweight) |
| Patients with left ventricular assist device implantation:Renal function | first 72 hours | creatinine level |
| Patients with left ventricular assist device implantation:Lactate level | first 72 hours | Lactate level |
| For operations with prolonged artificial circulation, hypothermia and circulatory arrest: Difference of Cytokine response | 24-48 hours | Level of pro- and anti-inflammatory cytokines (IL-1, IL-6, IL-8, IL-10, tumor necrosis factor-alfa, procalcitonin, C-reactive protein) |
| For operations with prolonged artificial circulation, hypothermia and circulatory arrest: SOFA-Score | 24, 48, 72 hours | Sequential Organ Failure Assessment Score at 24, 48, 72 h (values from 6 to 24, where the higher values explain higher disease severity) |
| Extracorporeal life support system with pulmonary and / or heart failure:Difference of mean arterial pressure | 24, 48, 72 hours | Comparison of mean arterial pressure at 24, 48, 72 hours between between two interventions (CytoSorb and Jafron) |
| Extracorporeal life support system with pulmonary and / or heart failure: Difference of CVP | 24, 48, 72 hours | Comparison of CVP at 24, 48, 72 hours between between two interventions (CytoSorb and Jafron) |
| Extracorporeal life support system with pulmonary and / or heart failure: Serum lactate | 24, 48, 72 hours | Level of serum lactate at 24, 48, 72 h |
| Extracorporeal life support system with pulmonary and / or heart failure:Days on ventilator, vasopressor and renal replacement therapy | until day 30 post-surgery | Total days on ventilator, vasopressor and renal replacement therapy within 30 days post-surgery will be assessed |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| For operations with prolonged cardiopulmonary bypass, hypothermia, and circulatory arrest: Application and dosage of inotropes | first 48 hours | Incidence of application and level of dosage of inotropes on days 2 and 3 after surgery |
| For operations with prolonged cardiopulmonary bypass, hypothermia, and circulatory arrest: The level of procalcitonin | 24-48 hours | The level of procalcitonin before the cardiopulmonary bypass 2 hours after the cardiopulmonary bypass, when the cardiopulmonary bypass is turned off, 24 hours after the cardiopulmonary bypass. |
| Extracorporeal life support system with pulmonary and / or heart failure:The level of C-reactive protein (CRP) | 24-48 hours | The level of C-reactive protein (CRP) before the start of ECMO, 2 hours after the implantation of ECMO, during ECMO, 24 hours after ECMO explantation. |
| Extracorporeal life support system with pulmonary and / or heart failure: Level of leukocyte | 24-48 hours | Level of leukocyte cells in the bloodstream at 24, 48 hours |
| Extracorporeal life support system with pulmonary and / or heart failure:Application and dosage of vasopressors | first 48 hours | Incidence of application and level of dosage of vasopressors on days 2 and 3 after surgery |
| Patients with left ventricular assist device implantation: The level of C-reactive protein (CRP) | 24-48 hours | The level of C-reactive protein (CRP) before the start of the operation, 2 hours after the start of the operation, when the operation is turned off, 24 hours after the shutdown of the operation |
| Patients with left ventricular assist device implantation: Application and dosage of vasopressors | first 48 hours | Incidence of application and level of dosage of vasopressors on days 2 and 3 after surgery |
| For operations with prolonged artificial circulation, hypothermia and circulatory arrest: The level of C-reactive protein (CRP) | 24-48 hours | The level of C-reactive protein (CRP) before the cardiopulmonary bypass 2 hours after the cardiopulmonary bypass, when the cardiopulmonary bypass is turned off, 24 hours after the cardiopulmonary bypass. |
| For operations with prolonged artificial circulation, hypothermia and circulatory arrest:Leukocyte function | first 48 hours | Leukocyte function: heterogeneity of the population of leukocyte cells in the bloodstream |
| For operations with prolonged artificial circulation, hypothermia and circulatory arrest: Application and dosage of vasopressors | first 48 hours | Incidence of application and level of dosage of vasopressors on days 2 and 3 after surgery |
| Extracorporeal life support system with pulmonary and / or heart failure:The level of leukocytes | 24-48 hours | The level of leukocytes before the start of ECMO, 2 hours after the implantation of ECMO, during ECMO, 24 hours after ECMO explantation |
| Extracorporeal life support system with pulmonary and / or heart failure:The level of procalcitonin | 24-48 hours | The level of procalcitonin before the start of ECMO, 2 hours after the implantation of ECMO, during ECMO, 24 hours after ECMO explantation. |
| Extracorporeal life support system with pulmonary and / or heart failure:Application and dosage of inotropes | first 48 hours | Incidence of application and level of dosage of inotropes on days 2 and 3 after surgery |
| Patients with left ventricular assist device implantation: The level of leukocytes | 24-48 hours | The level of leukocytes before the start of the operation, 2 hours after the start of the operation, when the operation is turned off, 24 hours after the shutdown of the operation |
| Patients with left ventricular assist device implantation: The level of procalcitonin | 24-48 hours | The level of procalcitonin before the start of the operation, 2 hours after the start of the operation, when the operation is turned off, 24 hours after the shutdown of the operation |
| Patients with left ventricular assist device implantation: Application and dosage of inotropes | first 48 hours | Incidence of application and level of dosage of inotropes on days 2 and 3 after surgery |
| For operations with prolonged cardio pulmonary bypass, hypothermia and circulatory arrest: The level of leukocytes | 24-48 hours | The level of leukocytes before the cardiopulmonary bypass 2 hours after the cardiopulmonary bypass, when the cardiopulmonary bypass is turned off, 24 hours after the cardiopulmonary bypass. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Length of stay | first 48 hours | Length of stay in the intensive care unit |
| 30 day survival rate. | 30 day | 30 day survival rate. |
| Length of hospital stay | up to 1 month | Length of hospital stay |
Countries
Kazakhstan
Contacts
Primary ContactYuri Pya, PhD, MD
Backup ContactTimur Lesbekov, MD
Outcome results
None listed