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Trial registered on ANZCTR
Registration number
ACTRN12617001263381
Ethics application status
Approved
Date submitted
25/08/2017
Date registered
1/09/2017
Date last updated
13/12/2018
Date data sharing statement initially provided
13/12/2018
Date results provided
13/12/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Magnesium after cardiac surgery practice change audit
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Scientific title
An audit of a change in the intensive care unit magnesium administration protocol in patients following cardiac surgery: effect on occurrence of atrial fibrillation
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Secondary ID [1]
292733
0
Nil Known
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Universal Trial Number (UTN)
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Trial acronym
MAGIC IV
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Electrolyte disturbance
304499
0
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Cardiovascular disease
304500
0
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CARDIAC SURGERY
304564
0
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Condition category
Condition code
Cardiovascular
303837
303837
0
0
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Coronary heart disease
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Surgery
303890
303890
0
0
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Other surgery
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Intervention/exposure
Study type
Observational
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Patient registry
False
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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
From 1st October 2017 until 31st March 2018, for all cardiac surgical patients at admission to the ICU following surgery, a loading dose of 10 mmol of magnesium sulphate diluted in 100 mL of saline will be administered intravenously over the period of 1 hour. After the end of the loading dose, a continuous infusion of magnesium sulphate will be commenced at a rate of 3 mmol/h (total extrapolated dose over 24 hours of 82 mmol). The continuous infusion will be maintained during the first 96 hours of ICU stay or until ICU discharge, whichever occurs first; and we will aim a serum magnesium concentration between 1.5 and 2.0 mmol/L with magnesium level monitoring twice daily.
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Intervention code [1]
298979
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Not applicable
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Comparator / control treatment
From 1st October 2016 until the 31st March 2017, for all cardiac surgical patients admitted to the ICU we will retrospectively collected data for their medical record
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Control group
Historical
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Outcomes
Primary outcome [1]
303200
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Occurrence of atrial fibrillation - hospital stay
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Assessment method [1]
303200
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Timepoint [1]
303200
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As documented in the patient's medical record as assessed from the time of admission to the intensive care unit through to discharge from the hospital
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Primary outcome [2]
303201
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Occurrence of atrial fibrillation - Intensive care unit admission
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Assessment method [2]
303201
0
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Timepoint [2]
303201
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As documented in the patient's medical record as assessed from the time of admission to the intensive care unit through to discharge from the intensive care unit
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Secondary outcome [1]
338222
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Duration of intensive care unit admisison
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Assessment method [1]
338222
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Timepoint [1]
338222
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Number of days that patient is admitted to the intensive care unit following cardiac surgery.
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Secondary outcome [2]
338223
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Duration of hospital admission
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Assessment method [2]
338223
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Timepoint [2]
338223
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Number of days that patient is admitted to the hospital following cardiac surgery.
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Secondary outcome [3]
338224
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Duration of mechanical ventilation
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Assessment method [3]
338224
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Timepoint [3]
338224
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The total number of hours of mechanical ventilation in the intensive care unit following cardiac surgery.
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Secondary outcome [4]
338225
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Mean serum magnesium concentration
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Assessment method [4]
338225
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Timepoint [4]
338225
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Mean serum magnesium concentration of the routine morning formal blood test during admission to intensive care
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Secondary outcome [5]
338226
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Dose of magnesium sulphate administered
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Assessment method [5]
338226
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Timepoint [5]
338226
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Total amount in mmol/L of magnesium sulphate administered to post-cardiac surgery patients during the intensive care admission
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Eligibility
Key inclusion criteria
Adult (aged 18 years or older) patients who are admitted to the intensive care unit following cardiac surgery.
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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
- known renal impairment
- treating intensive care unit consultant feels that it is not in the patient's best interest to be treated with the new magnesium supplementation protocol
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Study design
Purpose
Natural history
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Duration
Cross-sectional
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Selection
Convenience sample
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Timing
Both
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Statistical methods / analysis
We will apply descriptive and inferential statistical procedures to the data collected for the purposes of this audit. Baseline comparisons will be performed using Fisher’s exact tests and reported as n (%). Continuous normally distributed variables will be compared using Student t-tests and reported as means (standard deviation), while non-normally distributed data will be compared using Wilcoxon rank-sum tests and reported as medians [interquartile range]. Changes over time will be determined using repeated measures mixed linear modeling with each patient treated as a random effect, and therapy group, time and the interaction of therapy group and time as effect fixed effects.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/10/2017
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Actual
25/09/2017
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Date of last participant enrolment
Anticipated
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Actual
27/10/2017
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Date of last data collection
Anticipated
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Actual
30/11/2017
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Sample size
Target
200
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Accrual to date
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Final
60
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
8869
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Austin Health - Austin Hospital - Heidelberg
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Recruitment postcode(s) [1]
17119
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3084 - Heidelberg
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Funding & Sponsors
Funding source category [1]
297370
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Hospital
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Name [1]
297370
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Austin Hospital
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Address [1]
297370
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145 Studley Road
Heidelberg VIC 3084
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Country [1]
297370
0
Australia
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Primary sponsor type
Hospital
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Name
Austin Health
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Address
145 Studley Road
Heidelberg VIC 3084
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Country
Australia
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Secondary sponsor category [1]
296348
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Individual
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Name [1]
296348
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Professor Rinaldo Bellomo
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Address [1]
296348
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Director, Intensive Care Research
Department of Intensive Care
Austin Hospital
145 Studley Road
Heidelberg, VIC 3084
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Country [1]
296348
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
298474
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Austin Health Human Research Ethics Committee
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Ethics committee address [1]
298474
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Austin Hospital 145 Studley Road Heidelberg VIC 3084
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Ethics committee country [1]
298474
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Australia
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Date submitted for ethics approval [1]
298474
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16/08/2017
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Approval date [1]
298474
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22/08/2017
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Ethics approval number [1]
298474
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LNR/17/Austin/416
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Summary
Brief summary
Atrial fibrillation (AF) is the most common complication after cardiac surgery, with an incidence ranging from 20 to 50%. It represents a potential cause of thromboembolic events, hemodynamic instability and prolonged Intensive Care Unit (ICU) stay. Maintaining a normal blood magnesium concentration may help prevent the onset of atrial fibrillation after cardiac surgery. Previously we performed an assessment of the pharmacokinetics of magnesium administration after cardiothoracic surgery from August, 2016 to April, 2017: “Assessment of Blood and Urine Magnesium Levels in Patients Admitted to the Intensive Care Unit” (HREC: LNR/15/Austin/306). We included 60 patients: 30 patients in the before period who received a bolus of 20 mmol of magnesium sulphate over 1 hour; and 30 patients in the after period who received a bolus of 10 mmol of magnesium sulphate followed by a continuous infusion at 3 mmol/h over 12 hours. In the before period, we found that the loading dose of 20 mmol increased both serum and urinary magnesium concentrations, however the serum concentration returned to pre-intervention levels within 12 hours of observation and the urinary excretion remained elevated. In the after period, the intervention of a loading dose of 10 mmol of magnesium sulphate followed by a continuous infusion was associated with an increase of both the serum and urinary concentrations of magnesium over time. The after-period protocol allowed us to achieve a sustained, safe, and moderately elevated serum magnesium concentration at twice to three times the lowest total magnesium concentration in our laboratory (1.4 to 2.0 mmol/L), which might be expected to deliver a greater chance of AF prevention. As such the management practices associated with magnesium administration in our intensive care unit has changed. The purpose of this project is to evaluate the effect of the new protocol on the incidence of atrial fibrillation in patients who undergo cardiac surgery and are admitted to the intensive care unit. Using a medical record audit design we will evaluate patients treated with the new magnesium protocol with that of a historical control.
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Trial website
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Trial related presentations / publications
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Public notes
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Attachments [1]
1994
1994
0
0
/AnzctrAttachments/373534-20170822 LETTER LNR17Austin416 Ethics New Study Approval (Audit).pdf
(Ethics approval)
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Contacts
Principal investigator
Name
77194
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Prof Rinaldo Bellomo
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Address
77194
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Department of Intensive Care
Austin Hospital
145 Studley Road
Heidelberg VIC 3084
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Country
77194
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Australia
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Phone
77194
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+61 3 9496 5992
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Fax
77194
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+61 3 9496 3932
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Email
77194
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[email protected]
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Contact person for public queries
Name
77195
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Glenn Eastwood
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Address
77195
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Department of Intensive Care
Austin Hospital
145 Studley Road
Heidelberg VIC 3084
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Country
77195
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Australia
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Phone
77195
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+61 3 9496 4835
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Fax
77195
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+61 3 9496 3932
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Email
77195
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[email protected]
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Contact person for scientific queries
Name
77196
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Rinaldo Bellomo
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Address
77196
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Department of Intensive Care
Austin Hospital
145 Studley Road
Heidelberg VIC 3084
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Country
77196
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Australia
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Phone
77196
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+61 3 9496 4835
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Fax
77196
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+61 3 9496 3932
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Email
77196
0
[email protected]
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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
pilot single centre investigation with the aim of providing preliminary safety data and only be hypothesis generating.
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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
Source
Title
Year of Publication
DOI
Embase
Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study.
2020
https://dx.doi.org/10.1053/j.jvca.2020.04.006
N.B. These documents automatically identified may not have been verified by the study sponsor.
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