Pilot Study on HA380 Column Use in Critically Ill Patients Receiving Extracorporeal Support.
- Conditions
- Extracorporeal Circulation; ComplicationsAcute Kidney InjuryARDSInflammation
- Interventions
- Device: HA 380
- Registration Number
- NCT06179771
- Lead Sponsor
- University Hospitals, Leicester
- Brief Summary
Patients who are very ill either due to a severe infection, major organ injury, trauma or a major operation may require significant support with devices such as a dialysis machine for the kidneys or Extracorporeal Membrane Oxygenation (ECMO) for the heart and lungs. This is often due to a reaction of the body to the insult which is termed inflammation. The investigators would like to assess if the use of a device that can remove the agents driving this reaction can lead to a quicker recovery form the illness. The device is a blood filter called HA380 and it would be connected to either the dialysis machine or the ECMO circuit. The investigators want to assess the feasibility of conducting a study with the HA380 column. We will also evaluate if the use of the HA380 column has an effect on the time spent on dialysis or ECMO, time spent on the breathing machine, time spent requiring drugs to support blood pressure and time spent in the intensive care unit.
- Detailed Description
The role of inflammation in the pathophysiology of major organ dysfunction in critically ill patients is well established and this correlates with the degree of organ dysfunction which consequently may require increased level of organ support in the intensive care unit. Critically ill patients present in a spectrum of inflammatory states and on the extreme end of this spectrum are patients requiring renal replacement therapy and ECMO support. This subgroup of critically ill patients have been found to have high mortality.
The concept of attenuating severe hyperinflammatory response is sometimes used in certain disease states using agents such as intravenous corticosteroids, plasma exchange and more recently, anti-cytokine monoclonal antibodies. However, these strategies are associated with side effects (e.g. Bleeding and increased risk of infection), and are not necessarily appropriate in all critically ill patients with severe inflammation. Studies investigating the efficacy of these strategies have failed to show any clinical benefit except in the setting of COVID 19 infection.1-4 Early use of cytokine adsorption devices may provide an alternative non- pharmacological pathway with fewer side effects which can be deployed early.
The most studied cytokine adsorption device is the CytoSorb column which consists of biocompatible polymer sorbent beads. Several studies have demonstrated a reduction in vasopressor requirements, IL-6 levels, and Sequential Organ Failure Assessment (SOFA) scores.5,6 However, this observation did not translate into outcome benefit. There is considerable heterogeneity in how the cytokine adsorption is delivered in these studies and the study designs. An international registry analysis did not demonstrate a mortality benefit with CytoSorb either.7
The HA380 column consists of styrene divinylbenzene copolymers. In a recent study consisting of patients undergoing cardio-pulmonary bypass, patients who received the HA 380 column required lower vasopressor doses, shorter duration of invasive mechanical ventilation and had a shorter ICU length of stay.8 A direct in- vitro comparison of the CytoSorb device and the HA 380 device shows that the latter is less efficient at removing cytokines compared to the CytoSorb device but both devices were efficient at removing pro-inflammatory cytokines.9 The role of cytokines in critical illness is a double-edged sword10, and this may well be where CytoSorb may have a disadvantage - providing higher cytokine clearance for a longer period.
We hypothesise that the HA380 column use in critically ill patients with inflammation receiving renal replacement therapy or ECMO is associated with an improvement in mortality. It is recommended to be used early (within 72 hours of commencement of extracorporeal support). HA380 hemoperfusion cartridge, mainly adsorbs molecules from 10 to 60 kDa. Because of the accurate 3D macroporous structure and over 54000 m2 adsorption surface area of the resin.HA380 haemoperfusion therapy can provide a new regimen in controlling inflammatory cytokines storm. Studies have demonstrated the ability of the HA380 column to reduce the concentration of pro-inflammatory cytokines IL-1, TNF-alpha. 11,12
The aim of this feasibility pilot is to assess the feasibility of the early use of the HA380 cytokine adsorption column in a study and its effect on the time-to-liberation from extracorporeal membrane oxygenation (ECMO) support, vasoactive drug requirement and duration of vasoactive therapy, and mortality (or clinical surrogates for all-cause mortality).
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 40
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Interventional HA 380 Patients assigned to interventional arm will receive treatment with a cytokine adsorption device (HA 380) within 72 hours of being admitted to ICU. This is in addition to standard evidence based ICU care. Each patient will receive 2 treatments each lasting a maximum of 6 hours in a 24 hour period.
- Primary Outcome Measures
Name Time Method Ability to recruit the sample size of eligible patients within the study period. through study completion, an average of 24 months Proportion of the sample size recruited into the study during the study period.
Successful use of HA380 column in critically ill patients. through study completion, an average of 24 months Number of patients unable to tolerate treatment with HA380 column.
- Secondary Outcome Measures
Name Time Method Time spent on vasopressor therapy. From date admission to ICU, assessed up to 4 weeks Hours spent requiring vasopressor support.
Time spent on extracorporeal support From the date of admission to ICU, assessed up to 24 weeks Days spent on extracorporeal support.
Time spent in ICU From date of admission to ICU until the date of ICU discharge or date of death, which ever comes first, assessed up to 24 months Days spent in ICU
ICU Mortality From the date of admission to ICU until the date of death from any cause during ICU stay, assessed up to 24 months Death in ICU
Trial Locations
- Locations (1)
University Hospitals of Leicester NHS Trust
🇬🇧Leicester, Leicestershire, United Kingdom