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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03714048
Registration number
NCT03714048
Ethics application status
Date submitted
16/10/2018
Date registered
22/10/2018
Titles & IDs
Public title
Blood Management During ECMO for Cardiac Support
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Scientific title
International Observational Study on BLood Management for Mechanical Circulatory Support Using Extracorporeal Membrane Oxygenation (OBLEX)
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Secondary ID [1]
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HREC/18/SVH/202
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Universal Trial Number (UTN)
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Trial acronym
OBLEX
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Death, Sudden, Cardiac
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HEART ARREST
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Shock, Cardiogenic
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Arrhythmias, Cardiac
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Hemorrhage
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Venous Thrombosis
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0
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Embolism
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Blood Transfusion
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0
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Disseminated Intravascular Coagulation
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0
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Condition category
Condition code
Cardiovascular
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Diseases of the vasculature and circulation including the lymphatic system
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Cardiovascular
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Other cardiovascular diseases
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Blood
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Clotting disorders
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Cardiovascular
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Coronary heart disease
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Blood
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Clotting disorders
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Intervention/exposure
Study type
Observational [Patient Registry]
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Patient registry
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Perioperative -
Cardiogenic shock minus arrest -
Cardiogenic shock plus arrest -
Preventive -
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Hospital mortality
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Assessment method [1]
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Fraction of patients not surviving the index hospital admission
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Timepoint [1]
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Till the end of the index hospital admission, on average 30 days
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Secondary outcome [1]
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ECMO free days
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Assessment method [1]
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Number of days alive and not treated with ECMO during the first 28 days after the start of the treatment
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Timepoint [1]
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28 days after the start of the treatment
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Secondary outcome [2]
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ICU free days
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Assessment method [2]
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Number of days alive and not treated in ICU during the first 28 days after the start of the treatment
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Timepoint [2]
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28 days after the start of the treatment
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Secondary outcome [3]
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Ventilator free days
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Assessment method [3]
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Number of days alive and not treated with mechanical ventilation during the first 28 days after the start of the treatment
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Timepoint [3]
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28 days after the start of the treatment
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Secondary outcome [4]
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Anticoagulation management
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Assessment method [4]
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Parameter used to titrate anticoagulation, drug used and achieved values
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Timepoint [4]
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For 7 days after the start of ECMO or till the end of treatment (whatever comes first)
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Secondary outcome [5]
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Hemorrhagic complications
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Assessment method [5]
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Type, location and management of hemorrhage
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Timepoint [5]
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For 7 days after the start of ECMO or till the end of treatment (whatever comes first)
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Secondary outcome [6]
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Thromboembolic complications
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Assessment method [6]
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Type, location and management of thromboembolic complication
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Timepoint [6]
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For 7 days after the start of ECMO or till the end of treatment (whatever comes first)
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Eligibility
Key inclusion criteria
* ECMO for mechanical circulatory support
* ECMO using a temporary device containing an oxygenator and an active blood pump.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* ECMO for respiratory support only
* Age<18
* ECMO treatment outside the participating centre for >24 hours
* Previous enrolment in OBLEX during the same hospital admission
* ECMO treatment outside the intensive care unit only (e.g. theatre or angiography)
* Enrolment in other studies where a randomized intervention is targeting anticoagulation or blood management.
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Study design
Purpose
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Duration
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Selection
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Timing
Prospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/07/2019
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
15/04/2023
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Sample size
Target
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Accrual to date
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Final
561
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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St Vincent's Hospital - Sydney
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Recruitment postcode(s) [1]
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2010 - Sydney
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Funding & Sponsors
Primary sponsor type
Other
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Name
St Vincent's Hospital, Sydney
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure used to treat severe forms of heart and/or lung failure. It works by the principal of replacing the function of these organs by taking blood from the patient, provide it with oxygen outside the body and return it to the patient in one continuous circuit. Because of the evaluability of better technology, the use of ECMO has exponentially risen over the last decade. This treatment is very invasive and carries a number of risks. It is mostly used in situations where it seems likely that the patient would otherwise die and no other less invasive measure could change this. Still in large registries 50-60% of patients die which is often due to complications associated with the treatment. One of the most important complication is caused by the activation of clotting factors during the contact with the artificial surfaces of the device. This can lead to clot formation inside the patient or the device. To counterbalance this anticoagulation is needed. Because of the consumption of clotting factors and the heparin therapy bleeding complications are also very common in ECMO. Clinicians are challenged to balance these competing risks and are often forced to transfuse blood products to treat these conditions, which comes with additional risks for the patient. Many experienced centres have reported thromboembolic and bleeding events as the most important contributor to a poor outcome of this procedure. However, no international study combining the experience of multiple centres to compare their practice and identify risk factors which can be altered to reduce these risks. This study has been endorsed by the international ECMONet and aims to observe the practice in up to 50 centres and 500 patients worldwide to generate the largest ever published database on this topic. It will concentrate on patients with severe heart failure and will be able to identify specific risk factors for thromboembolic and bleeding events. Some of these factors may be modifiable by change in practice and can subsequently be evaluated in clinical trials. Some of these factors may include target values for heparin therapy and infusion of clotting factors. This study will directly improve patient management by informing clinicians which measures are associated with the best outcome and indirectly helps building trials to increase the evidence further.
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Trial website
https://clinicaltrials.gov/study/NCT03714048
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Trial related presentations / publications
Buscher H, Hayward C. Extracorporeal Membrane Oxygenation: An Expanding Role in Cardiovascular Care. Heart Lung Circ. 2018 Jan;27(1):3-5. doi: 10.1016/S1443-9506(17)31472-5. No abstract available. Buscher H, Zhang D, Nair P. A pilot, randomised controlled trial of a rotational thromboelastometry-based algorithm to treat bleeding episodes in extracorporeal life support: the TEM Protocol in ECLS Study (TEMPEST). Crit Care Resusc. 2017 Oct;19(Suppl 1):29-36. Smith M, Vukomanovic A, Brodie D, Thiagarajan R, Rycus P, Buscher H. Duration of veno-arterial extracorporeal life support (VA ECMO) and outcome: an analysis of the Extracorporeal Life Support Organization (ELSO) registry. Crit Care. 2017 Mar 6;21(1):45. doi: 10.1186/s13054-017-1633-1. Buscher H, Vukomanovic A, Benzimra M, Okada K, Nair P. Blood and Anticoagulation Management in Extracorporeal Membrane Oxygenation for Surgical and Nonsurgical Patients: A Single-Center Retrospective Review. J Cardiothorac Vasc Anesth. 2017 Jun;31(3):869-875. doi: 10.1053/j.jvca.2016.10.015. Epub 2016 Oct 17. Venkatesh K, Nair PS, Hoechter DJ, Buscher H. Current limitations of the assessment of haemostasis in adult extracorporeal membrane oxygenation patients and the role of point-of-care testing. Anaesth Intensive Care. 2016 Nov;44(6):669-680. doi: 10.1177/0310057X1604400601. Nair P, Hoechter DJ, Buscher H, Venkatesh K, Whittam S, Joseph J, Jansz P. Prospective observational study of hemostatic alterations during adult extracorporeal membrane oxygenation (ECMO) using point-of-care thromboelastometry and platelet aggregometry. J Cardiothorac Vasc Anesth. 2015 Apr;29(2):288-96. doi: 10.1053/j.jvca.2014.06.006. Epub 2015 Feb 2. Herbert DG, Buscher H, Nair P. Prolonged venovenous extracorporeal membrane oxygenation without anticoagulation: a case of Goodpasture syndrome-related pulmonary haemorrhage. Crit Care Resusc. 2014 Mar;16(1):69-72.
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Type
Citations or Other Details
Journal
Buscher H, Hayward C. Extracorporeal Membrane Oxyg...
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Journal
Buscher H, Zhang D, Nair P. A pilot, randomised co...
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Journal
Smith M, Vukomanovic A, Brodie D, Thiagarajan R, R...
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Buscher H, Vukomanovic A, Benzimra M, Okada K, Nai...
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Venkatesh K, Nair PS, Hoechter DJ, Buscher H. Curr...
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Nair P, Hoechter DJ, Buscher H, Venkatesh K, Whitt...
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Journal
Herbert DG, Buscher H, Nair P. Prolonged venovenou...
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Results not provided in
https://clinicaltrials.gov/study/NCT03714048