Transfusion Requirements in Younger Patients Undergoing Cardiac Surgery
- Conditions
- Cardiac SurgeryDisorderPostoperativeHeart
- Interventions
- Other: Restrictive Transfusion StrategyOther: Liberal transfusion strategy
- Registration Number
- NCT04754022
- Lead Sponsor
- Unity Health Toronto
- Brief Summary
TRICS-IV is an international, multi-centre, open-label randomized controlled trial of two commonly used transfusion strategies in moderate to high risk patients who are 65 years of age or younger undergoing cardiac surgery on cardiopulmonary bypass, using a superiority trial design.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 1440
- ≥18 and ≤65 years of age
- Planned cardiac surgery using cardiopulmonary bypass
- Informed consent obtained
- Preoperative European System for Cardiac Operative Risk Evaluation (EuroSCORE I) of 6 or more
- Patients who refuse participation
- Patients who are unable to receive or who refuse blood products
- Patients who are involved in a preoperative autologous pre-donation program
- Patients who are having a heart transplant or having surgery solely for an insertion of a ventricular assist device
- Pregnancy or lactation (a negative pregnancy test must be obtained prior to randomization for women of childbearing potential)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Restrictive Transfusion Strategy Restrictive Transfusion Strategy Patients will receive a RBC transfusion if their Hb concentration is \<75 g/L (\<7.5 g/dL; \<4.7mmol/L) intraoperatively and/or postoperatively. Liberal Transfusion Strategy Liberal transfusion strategy Patients will receive a RBC transfusion if their Hb concentration is \<95 g/L (\<9.5 g/dL; \<5.9mmol/L) intraoperatively, or postoperatively in the ICU; and/or \<85 g/L (\< 8.5 g/dL; \<5.3mmol/L) on the ward.
- Primary Outcome Measures
Name Time Method Composite score of any one of the following events occurring 6 months after cardiac surgery: (1) all-cause mortality; (2) myocardial infarction; (3) new onset renal failure requiring dialysis; or (4) new focal neurological deficit (stroke). Within 6 months after cardiac surgery. Any of all-cause mortality, myocardial infarction, new onset renal failure requiring dialysis, or new focal neurological deficit (stroke).
- Secondary Outcome Measures
Name Time Method Composite and individual all-cause mortality, myocardial infarction, new onset renal failure requiring dialysis, and new focal neurological deficit (stroke). Up to hospital discharge or after 28 days postoperatively, whichever comes first. Composite and individual incidence of all-cause mortality, myocardial infarction, new onset renal failure requiring dialysis, and new focal neurological deficit (stroke).
Length of stay in the ICU and hospital. Up to hospital discharge or after 28 days postoperatively, whichever comes first. Length of stay in the ICU and hospital in days.
Acute kidney injury. Up to hospital discharge or after 28 days postoperatively, whichever comes first. Defined by the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline - a 50% increase in serum creatinine within 1 week or a 26.5 mmol/L increase within 48 hours.
Duration of mechanical ventilation. Up to hospital discharge or after 28 days postoperatively, whichever comes first. Time on mechanical ventilation.
Incidence of infection. Up to hospital discharge or after 28 days postoperatively, whichever comes first. Defined as septic shock with positive blood cultures; pneumonia defined as autopsy diagnosis or roentgenographic infiltrate and at least two out of three of the following criteria: fever, leukocytosis, and positive sputum culture; and/or deep sternal or leg wound infection requiring intravenous antibiotics and/or surgical debridement.
Prolonged low output state. Up to hospital discharge or after 28 days postoperatively, whichever comes first. Defined as the need for two or more inotropes for 24 hours or more, intra-aortic balloon pump or ventricular assist device postoperatively.
Delirium. Up to hospital discharge or after 28 days postoperatively, whichever comes first. Confusion Assessment Method (CAM) or CAM-ICU (even on 1 occasion), or Intensive Care Delirium Screening Checklist (ICDSC) \> 3, or 3D-CAM, or 4AT ≥4, or more than one dose of haloperidol or similar antipsychotic drug, or documented delirium by neurologist or neurosurgeon or psychiatrist consultation.
Hospital visits. Within 6 months after cardiac surgery. Hospitalization and/or emergency visits and coronary revascularization after index procedure.
Incidence of encephalopathy. Up to hospital discharge or after 28 days postoperatively, whichever comes first. Unexpected delayed awakening or severely altered mental status (unconscious despite no sedative medication for more than 5 days), or encephalopathy documented by neurologist or neurosurgeon or psychiatrist consultation.
Incidence of each individual component of the primary outcome: all-cause mortality, myocardial infarction, new onset renal failure requiring dialysis, and new focal neurological deficit (stroke). Within 6 months after cardiac surgery. Incidence of all-cause mortality, myocardial infarction, new onset renal failure requiring dialysis, and new focal neurological deficit (stroke).
Incidence of gut infarction. Up to hospital discharge or after 28 days postoperatively, whichever comes first. Confirmed by imaging (e.g. angiography), autopsy, or through surgical means.
Incidence of seizures. Up to hospital discharge or after 28 days postoperatively, whichever comes first. Generalized or focal tonic-clonic movements consistent with seizure; or electroencephalogram demonstrating epileptiform discharges; or diagnosis of seizures by neurologist or neurosurgeon consultation.
Transfusion requirements. Up to hospital discharge or after 28 days postoperatively, whichever comes first. The proportion of patients transfused and the number of blood products utilized (RBCs, plasma, platelets).
Trial Locations
- Locations (54)
Maine Medical Center
🇺🇸Portland, Maine, United States
The Cooper Health System
🇺🇸Camden, New Jersey, United States
Columbia University
🇺🇸New York, New York, United States
Thomas Jefferson University
🇺🇸Philadelphia, Pennsylvania, United States
Royal Prince Alfred hospital
🇦🇺Camperdown, New South Wales, Australia
Prince of Wales Hospital
🇦🇺Randwick, New South Wales, Australia
Westmead Hospital
🇦🇺Westmead, New South Wales, Australia
Gold Coast University Hospital
🇦🇺Southport, Queensland, Australia
Flinders Medical Centre
🇦🇺Bedford Park, South Australia, Australia
Monash Health
🇦🇺Clayton, Victoria, Australia
St Vincent's Hospital Melbourne
🇦🇺Fitzroy, Victoria, Australia
Austin Health
🇦🇺Heidelberg, Victoria, Australia
Royal Adelaide Hospital
🇦🇺Adelaide, Australia
Royal Melbourne Hospital
🇦🇺Melbourne, Australia
Alfred Hospital
🇦🇺Prahran, Australia
University of Alberta Hospital
🇨🇦Edmonton, Alberta, Canada
Vancouver General Hospital
🇨🇦Vancouver, British Columbia, Canada
Kingston Health Sciences Centre
🇨🇦Kingston, Ontario, Canada
Health Sciences North Research Institute
🇨🇦Sudbury, Ontario, Canada
Sunnybrook Health Sciences Center
🇨🇦Toronto, Ontario, Canada
Toronto General Hospital
🇨🇦Toronto, Ontario, Canada
Montreal Heart Institute
🇨🇦Montreal, Quebec, Canada
Jewish General Hospital
🇨🇦Montreal, Quebec, Canada
Hôpital Sacré-Cœur de Montréal
🇨🇦Montréal, Quebec, Canada
Hospital Universitario San Ignacio
🇨🇴Bogota, Colombia
Fundacion Abood Shaio
🇨🇴Bogota, Colombia
Fundacion Cardioinfantil
🇨🇴Bogota, Colombia
Nasr City Health Insurance Hospital
🇪🇬Naşr, Cairo, Egypt
Democritus University of Thrace
🇬🇷Alexandroupolis, Evros, Greece
EPIC Hospital
🇮🇳Ahmedabad, Gujrat, India
Windhoek Central Hospital
🇳🇦Windhoek, Khomas, Namibia
Shahid Gangalal National Heart Center
🇳🇵Kathmandu, Nepal
Emergency Institute of Cardiovascular Diseases
🇷🇴Bucharest, Romania
National Heart Centre
🇸🇬Singapore, Singapore
Charlotte Maxeke Johannesburg Academic Hospital
🇿🇦Johannesburg, Gauteng, South Africa
Hospital de la Santa Creu I Sant Pau
🇪🇸Barcelona, Catalonia, Spain
Hospital General Universitari de Valencia
🇪🇸Valencia, Spain
Hospital Universitario La Fe Valencia
🇪🇸Valencia, Spain
University Hospital Basel
🇨🇭Basel, Switzerland
Inselspital, University Hospital Bern, University of Bern
🇨🇭Bern, Switzerland
University Hospital Leicester
🇬🇧Leicester, East Midlands, United Kingdom
Basildon University Hospitals-Mid and South Essex NHS Trust
🇬🇧Basildon, Essex, United Kingdom
University Hospital Southampton Foundation Trust
🇬🇧Southampton, Hampshire, United Kingdom
University Hospitals Sussex NHS Foundation Trust
🇬🇧Brighton, United Kingdom
University Hospitals Bristol and Weston NHS Foundation Trust
🇬🇧Bristol, United Kingdom
Royal Papworth Hospital NHS Foundation Trust.
🇬🇧Cambridge, United Kingdom
Manchester University NHS Foundation Trust
🇬🇧Wythenshawe, United Kingdom
Interior Health Kelowna General Hospital
🇨🇦Kelowna, British Columbia, Canada
Saint John Regional Hospitall
🇨🇦Saint John, New Brunswick, Canada
Hamilton Health Sciences Centre / Hamilton General Hospital
🇨🇦Hamilton, Ontario, Canada
St. Michael's Hospital, Unity Health Toronto
🇨🇦Toronto, Ontario, Canada
Centre hospitalier de l'Université de Montréal
🇨🇦Montréal, Quebec, Canada
Institut universitaire de cardiologie et de pneumology de Québec - université Laval (IUCPQ-UL)
🇨🇦Québec, Quebec, Canada
Saint-Petersburg State University Hospital
🇷🇺Saint Petersburg, Russian Federation