Preservation of renal function in cardiac surgery patients with low cardiac output syndrome: levosimendan vs beta agonists

ISRCTN ISRCTN46058317
DOI https://doi.org/10.1186/ISRCTN46058317
Secondary identifying numbers CEIMAN-26-2-14/BGC
Submission date
28/06/2019
Registration date
07/10/2019
Last edited
19/11/2019
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Circulatory System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Research has been conducted to assess the effects of the drug levosimendan on heart function when given to patients with low cardiac output syndrome (LCOS) in the period immediately after heart surgery. Postoperative kidney failure is an independent predictor of mortality. Levosimendan is used for LCOS and – apart from its cardioprotective effects – seems to have a protective role on kidney function. The aim of this study is to find out whether the use of levosimendan as compared to beta-agonists in heart surgery patients with LCOS and kidney failure has beneficial effects on kidney function that are independent from its cardioprotective effects.

Who can participate?
Patients with low cardiac output syndrome (LCOS)

What does the study involve?
Participants are treated with either beta-agonists or levosimendan. The incidence of postoperative kidney failure is assessed.

What are the possible benefits and risks of participating?
These are the same as usual treatment.

Where is the study run from?
HU Virgen de la Victoria (Spain)

When is the study starting and how long is it expected to run for?
January 2015 to May 2018

Who is funding the study?
FIMABIS (Spain)

Who is the main contact?
Dr Jose Luis Guerrero Orriach
guerreroorriach@gmail.com

Contact information

Dr Jose Luis Guerrero Orriach
Scientific

Campus Teatinos Sn Hu Virgen De La Victoria
Malaga
29006
Spain

Phone +34 (0)951032229
Email guerreroorriach@gmail.com

Study information

Study designQuasi-experiment study
Primary study designInterventional
Secondary study designNon randomised study
Study setting(s)Hospital
Study typeTreatment
Scientific titlePreservation of renal function in cardiac surgery patients with low cardiac output syndrome: levosimendan vs beta agonists
Study acronymCEIMAN-26-2-14/BGC
Study objectivesIt is postulated that the use of levosimendan as compared to beta-agonists in cardiac surgery patients with LCOS and kidney failure exerts beneficial preconditioning effects on renal function that are independent from its cardioprotective effects.
Ethics approval(s)Approved 27/02/2014, CEI Malaga Norte (Hospital Regional Universitario, 7ª planta Pabellón A, Avda. –Carlos Haya s/n, 29010-Málaga, Spain; Tel: +34 (0)951 29 1447/+34 (0)951 29 1977), no reference numbers attached
Health condition(s) or problem(s) studiedLow cardiac output syndrome (LCOS)
InterventionIt was a quasi-experiment study used to estimate the causal impact of an intervention on the target population without random assignment. Quasi-experimental research shares similarities with the traditional experimental design or randomized controlled trial, but it specifically lacks the element of random assignment to treatment or control. As it was a quasi-experimental study, recruitment was maintained until 50 patients were reached in each of the groups.

Patients were divided into two groups based on the therapy received, namely beta-agonists vs levosimendan. The administration of beta-agonists was maintained until LCOS resolution, whereas levosimendan was administered for 24 h at a rate of 0.1 mcg/kg/min at a target dose of 12.5 mg. The objectives of the therapy included a CI >2 l/min/m2 with a central venous saturation > 65% following volume replacement. Data were collected during the preoperative (heart and renal function data prior to surgery) and intraoperative period, at diagnosis of LCOS, at 24 h and at 48 h after diagnosis (24 h following completion of levosimendan therapy) and at discharge from the ICU.
Intervention typeDrug
Pharmaceutical study type(s)
PhaseNot Applicable
Drug / device / biological / vaccine name(s)Levosimendan, beta agonists
Primary outcome measureRenal function parameters:
1. Creatinine measured using ELISA at baseline, 24 and 48 hours and ICU discharge
2. Stage of renal failure measured by the Acute renal failure (AKI) scale at baseline, 24 and 48 hours and ICU discharge
3. Diuresis and use of diuretics (mg of furosemide) measured using diuresis output at baseline, 24 and 48 hours and ICU discharge
4. Requirement of renal replacement therapy measured using dialysis therapy at ICU discharge
Secondary outcome measuresHemodynamics:
1. HR (arrhythmia de novo) measured using EKG at baseline, 24 and 48 hours and ICU discharge
2. Multifocal atrial tachycardia (MAT) measured using EKG at baseline, 24 and 48 hours and ICU discharge
3. Heart failure (HF) measured using locs definition at baseline, 24 and 48 hours and ICU discharge
4. Ejection fraction of the left ventricle (EFLV) measured using Echo at baseline, 24 and 48 hours and ICU discharge
5. SvcO2 measured using oximetry at baseline, 24 and 48 hours and ICU discharge
6. Central venous pressure (CVP) measured using pressure transductor at baseline, 24 and 48 hours and ICU discharge
Overall study start date01/01/2015
Completion date01/05/2018

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants100
Total final enrolment100
Key inclusion criteria1. Patients older than 18 years who developed postoperative low cardiac output syndrome (LCOS) following heart surgery
2. LCOS (was defined as: a cardiac index < 2l/min/m2, or central venous saturation <65% after volume replacement) . It was checked by echocardiogram and Mostcare® (continuous cardiac index monitoring)
3. Patients who required inotropic support for the treatment of LCOS
Key exclusion criteria1. Patients who required combined surgery (not only cardiac surgery)
2. Emergency surgery
3. Preoperative diagnosis of chronic kidney failure
Date of first enrolment01/02/2015
Date of final enrolment01/05/2018

Locations

Countries of recruitment

  • Spain

Study participating centre

Hu Virgen De La Victoria
Campus Teatinos SN
Malaga
29006
Spain

Sponsor information

FIMABIS
Research organisation

Calle Dr. Miguel Díaz Recio, 28
Malaga
29010
Spain

Phone +34 (0)951440260
Email fimabis@fimabis.org
ROR logo "ROR" https://ror.org/002nw1r81

Funders

Funder type

Research organisation

FIMABIS

No information available

Results and Publications

Intention to publish date01/07/2019
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryOther
Publication and dissemination planPlanned publication in BMC Anesthesiology.
IPD sharing planThe datasets generated and/or analysed during the current study during this study will be included in the subsequent results publication.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 17/11/2019 19/11/2019 Yes No

Editorial Notes

19/11/2019: The following changes were made to the trial record:
1. Publication reference added.
2. The total final enrolment was added.
05/07/2019: Trial's existence confirmed by ethics committee.