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Trial registered on ANZCTR
Registration number
ACTRN12613000293763
Ethics application status
Approved
Date submitted
13/03/2013
Date registered
15/03/2013
Date last updated
15/03/2013
Type of registration
Retrospectively registered
Titles & IDs
Public title
Prophylactic intra-aortic balloon counterpulsation in high-risk cardiac surgery: An inception cohort study
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Scientific title
The effect of prophylactic intra-aortic balloon counterpulsation in high-risk cardaic surgery patients on mortality and quality of life at 6 months: an inception cohort study
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Secondary ID [1]
282121
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nil
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Universal Trial Number (UTN)
U1111-1140-5781
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Trial acronym
The PINBALL study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
High-risk cardiac surgery
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Ischaemic heart disease
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Condition category
Condition code
Cardiovascular
288949
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0
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Coronary heart disease
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Surgery
288962
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0
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Surgical techniques
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Intervention/exposure
Study type
Observational
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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
This is an observational study to determine the effect of prophylactic intra-aortic balloon counterpulsation on 6 month mortality and quality of life. We will observe high-risk patients undergoing coronary artery bypass graft surgery and compare patients who receive intra-aortic balloon counterpulsation prior to surgery to those who proceed to surgery without intra-aortic balloon counterpulsation.
Intra-aortic balloon counterpulsation is the process of inserting an intraaortic balloon pump, into the aorta, via the femoral artery (much like a coronary angiogram is performed), and having the balloon inflate during diastole (when the heart is relaxed), and deflate rapidly at the beginning of systole (when the heart contracts or pumps). This results in an increase in blood flow to the arteries supplying the heart muscle, and also results in a reduction in the work that heart has to do to pump blood around the body.
Intra-aortic balloon counterpulsation is commonly performed to assist cardiac function in patients with poor heart function following acute myocardial infarction or in patients with poor heart function following cardiac surgery. Prophylactic intra-aortic balloon counterpulsation is performed by commencing intra-aortic balloon counterpulsation, prior to cardiac surgery, in patients at high risk of post operative complications, in an attempt to prevent these complications post-operatively.
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Intervention code [1]
286727
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Not applicable
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Comparator / control treatment
N/A
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Mortality at 6 months post surgery
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Assessment method [1]
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Timepoint [1]
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6 months post surgery
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Secondary outcome [1]
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Quality of life as measured by the EQ5D
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Assessment method [1]
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Timepoint [1]
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6 months post surgery
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Secondary outcome [2]
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adverse events attributable to intra-aortic balloon counterpulsation including local complications, ischaemia to the limb, bleeding, infection and haemolysis
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Assessment method [2]
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Timepoint [2]
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Monitored in a daily basis during the hospital stay
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Secondary outcome [3]
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mortality within 30 days of surgery
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Assessment method [3]
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Timepoint [3]
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Within 30 days of surgery
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Secondary outcome [4]
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Composite of mortality, stroke, acute kidney injury and acute myocardial infarction. Stroke will be assessed on clinical grounds, acute kidney injury will be assessed on biochemical grounds and requirement for dialysis and acute myocardial infarction will be assessed using troponin measurements.
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Assessment method [4]
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Timepoint [4]
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Monitored throughout the post operative hospital stay
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Eligibility
Key inclusion criteria
Patients booked for coronary artery bypass graft surgery with at least two of the following characteristics
- left ventricular ejection fraction <30%
- redo cardiac surgery
- unstable angina
- left main coronary artery stenosis > 50%
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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
Age < 18 years
The patients has a left ventricular assist device in situ prior to planned surgery
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Study design
Purpose
Screening
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
4/03/2013
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Actual
12/03/2013
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Date of last participant enrolment
Anticipated
30/09/2013
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
250
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,WA,VIC
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Recruitment hospital [1]
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Royal North Shore Hospital - St Leonards
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Recruitment hospital [2]
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North Shore Private Hospital - St Leonards
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Recruitment hospital [3]
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Royal Perth Hospital - Perth
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Recruitment hospital [4]
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The Alfred - Prahran
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Recruitment postcode(s) [1]
6578
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2065 - Royal North Shore Hospital
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Recruitment postcode(s) [2]
6579
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2065 - St Leonards
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Recruitment postcode(s) [3]
6580
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6000 - Perth
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Recruitment postcode(s) [4]
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3181 - Prahran
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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Cardiothoracic reseach grant scheme
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Address [1]
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Sydney Medical School Foundation
Sydney Medical School
Room 201, Edward Ford Building A27
The University of Sydney
NSW, 2006
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Country [1]
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Australia
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Primary sponsor type
University
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Name
Australia and New Zealand Cardiothoracic Surgery cardiac surgery database program
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Address
CCRET, School of Public Health and Preventative Medicine
Level 6, The Alfred Centre
99 Commercial Rd
Melbourne, Vic, 3004
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
285678
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Address [1]
285678
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Country [1]
285678
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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North shore private hospital human research ethics committee
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Ethics committee address [1]
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North Shore Private Hospital 3 Westbourne St St. Leonards, NSW, 2065
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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Approval date [1]
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28/02/2013
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Ethics approval number [1]
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NSPHEC 2012-013
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Summary
Brief summary
PINBALL Synopsis Background CABG surgery remains the treatment of choice for many patients with severe ischaemic heart disease, the leading cause of death in Australia and worldwide. Patients undergoing CABG surgery are increasingly older, have greater comorbidities and are at high-risk of serious adverse postoperative outcomes. Prophylactic IABC may reduce postoperative mortality and morbidity in high-risk patients however current evidence is inconclusive and use remains low. Aim To describe the incidence and outcomes of high-risk patients undergoing CABG surgery. Objectives 1. Assess the crude and adjusted odds ratio for the association between prophylactic IABC and six-month postoperative mortality 2. Determine the combination of preoperative characteristics identifying a group of patients in whom prophylactic IABC may be of greatest benefit 3. Describe current perioperative management strategies of high-risk patients undergoing CABG surgery 4. Determine the quality of life at six months of high-risk patients who have undergone CABG surgery 5. Obtain information critical to the design of a RCT of prophylactic IABC in high-risk patients undergoing CABG including the calculation of sample size, determination of recruitment rates and treatment protocols for the intervention and control arms Methods We will conduct a prospective multi-centre inception cohort study of high-risk patients undergoing CABG surgery. All patients booked for CABG surgery with at least two of four high-risk characteristics, (left ventricular fraction less than 30%, redo cardiac surgery, left main coronary artery stenosis greater than 50% and unstable angina), will be included in the study. A telephone follow-up will be conducted at six months post surgery to measure vital status and quality of life. Outcomes Primary outcome: -Six month all-cause mortality Secondary outcomes: - Incidence of high-risk surgery - In-hospital and 30-day mortality - Composite of in-hospital mortality, CVA, AKI, AMI - Duration of MV, ICU and hospital LOS - Adverse events directly attributable to IABC - Six month quality of life
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Ed Litton
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Address
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Department of Intensive Care Medicine
Royal Perth Hospital
Wellington St
Perth, WA, 6000
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Country
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Australia
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Phone
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+61 08 9224 2244
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Ed Litton
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Address
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Department of Intensive Care Medicine
Royal Perth Hospital
Wellington St
Perth, WA, 6000
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Country
38475
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Australia
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Phone
38475
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+61 08 9224 2244
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Fax
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Email
38475
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[email protected]
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Contact person for scientific queries
Name
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Ed Litton
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Address
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Department of Intensive Care Medicine
Royal Perth Hospital
Wellington St
Perth, WA, 6000
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Country
38476
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Australia
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Phone
38476
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+61-08-9224 2244
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Fax
38476
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Email
38476
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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