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| ID | Type | Description | Link |
|---|---|---|---|
| 2022-A02566-39 | Other Identifier | ANSM |
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Despite significant advances in patient blood management, cardiac surgery remains a surgical procedure at high risk for bleeding. Numerous perioperative blood conservation strategies have been developed for limiting the use of blood products. Among them, the processing of shed blood and residual cardiopulmonary bypass circuit volume with autotransfusion device is routinely used. Conventional centrifugation-based autotransfusion devices actually available only recover red blood cells while platelets and coagulation factors are almost totally lost. Consequently, large amounts of intraoperative cell salvage could significantly alter perioperative haemostasis. The SAME autotransfusion device (i-SEP, France) is a new and innovative filtration-based autotransfusion device able to recover erythrocytes, leukocytes but also platelets. By offering the opportunity to re-infuse to patients their own platelets in addition red blood cells, significantly improve perioperative haemostasis with this new device is expected. The purpose of the COLTRANE trial is to compare the quality of the perioperative haemostasis in cardiac surgical patients for whom intraoperative cell salvage will be performed using either the SAME autotransfusion device or conventional centrifugation-based device.
Because allogenic transfusion of blood products as well as surgical re-exploration for excessive bleeding are associated with poor outcomes and prolonged length of stay, the use of filtration-based SAME device by maintaining perioperative haemostasis could improve outcomes and reduce length of stay of high risk patients. The fact that patients receive their own platelets should also limit the risk of allo-immunization and immunomodulation which is recognized as one of the underlying mechanisms of perioperative increased risk of infection.
The SAME device is a new and innovative filtration-based autotransfusion device able to recover both erythrocytes and platelets. A multicentre single-arm clinical feasibility and safety trial conducted by our group, using SAME device on 50 cardiac surgical patients reported erythrocyte yield per cycle of 89%, post-treatment hematocrit of 43% with an excellent washing performance. In addition, the device recovered 52% of platelets, that were found unaltered by the device as demonstrated by a limited platelet activation and a strong response to thrombin-pathway stimulation assessed by flow cytometry. By offering the opportunity to re-infuse to the patients their own platelets in addition to their RBC, this new device might significantly improve perioperative haemostasis and thus decrease the need for blood products. It is well established that severe postoperative bleeding and blood products transfusion lead to increase morbidity and mortality. Consequently, an improvement of postoperative outcomes and a decrease in intensive care unit (ICU) and hospital length of stay may be expected. The fact that patients receive their own platelets should limit the risk of allo-immunization and immunomodulation which is recognized as one of the underlying mechanisms of perioperative increased risk of infection. Consequently, a reduction of infectious complication may be also expected.
The purpose of COLTRANE trial is to test the hypothesis that the intraoperative use of the filtration-based SAME autotransfusion device could improve perioperative haemostasis thereby reducing the proportion of patients exhibiting clinically significant perioperative bleeding (moderate to massive bleeding according the Universal Definition of Perioperative Bleeding (UDPB) classification).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Autotransfusion by filtration | Experimental | new filtration-based autotransfusion (SAME I-SEP device) |
|
| Autotransfusion by centrifugation | Other | centrifugation-based autotransfusion (routinely used in cardiac surgery centers) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Autotransfusion | Procedure | ANTIFIBRINOLYTIC THERAPY : tranexamic acid as antifibrinolytic therapy : dose after anaesthesia induction followed by continuous intravenous infusion until end INTRAOPERATIVE MANAGEMENT :
TRANSFUSION PROTOCOL :
In bleeding patients: The perioperative use of blood products will be managed according to results of conventional haemostasis tests or viscoelastic point of care tests when available in the center. |
| Measure | Description | Time Frame |
|---|---|---|
| Perioperative bleeding | The proportion of patients with clinically significant (moderate to massive) perioperative bleeding according to the Universal Definition for Perioperative Bleeding. | At the end of Day 1 |
| Measure | Description | Time Frame |
|---|---|---|
| total blood loss | Total blood loss from chest tubes within 12 and 24 postoperative hours and up to chest tubes removal (maximum 5 postoperative days) | Hours 12, Hours 24, up to 5 after operatives days |
| surgical re-exploration |
| Measure | Description | Time Frame |
|---|---|---|
| COST-BENEFIT |
|
Inclusion Criteria:
Adult patients (≥18 yr) affiliated or beneficiary of a social security scheme and undergoing on-pump cardiac surgery at high risk for bleeding with autotranfusion indication defined as:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Alexandre Ouattara, MD, PhD | Contact | 0557656866 | +33 | alexandre.ouattara@chu-bordeaux.fr |
| Antoine Beurton, MD | Contact | 0557677147 | antoine.beurton@chu-bordeaux.fr |
| Name | Affiliation | Role |
|---|---|---|
| Alexandre Ouattara, MD, PhD | University Hospital, Bordeaux | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU de Bordeaux, Hôpital cardiologique Haut Lévêque - GH Sud, Service Anesthésie Réanimation Cardiovasculaire | Recruiting | Bordeaux | France | 33076 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40669902 | Background | Beurton A, Mansour A, Benard A, Pernot M, Brett VE, Batsale C, Aitgougam A, Cordon A, Mouton C, Fresselinat A, Robert G, Imbault J, Nesseler N, Ouattara A. Centrifugation versus filtration-based cell salvage: impact on perioperative bleeding in cardiac surgery-the COLTRANE randomised clinical trial - study protocol. BMJ Open. 2025 Jul 16;15(7):e099423. doi: 10.1136/bmjopen-2025-099423. |
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Individual participant data (IPD) will be made available upon reasonable request to qualified researchers, following review and approval by the study sponsor and ethics committee.
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| ID | Term |
|---|---|
| D006470 | Hemorrhage |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D001804 | Blood Transfusion, Autologous |
| ID | Term |
|---|---|
| D001803 | Blood Transfusion |
| D001691 | Biological Therapy |
| D013812 | Therapeutics |
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Multicentre clinical trial, Randomized, Comparative, controlled, single blinded, superiority design, two groups.
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Surgical re-exploration for excessive bleeding within 5 postoperative days
| Day 0-Day 5, |
| Sternal closure | Delayed sternal closure | Hours 12 |
| Overall quality of perioperative haemostasis : Use of blood | Perioperative use of blood products and/or plasma derivatives within 2 postoperative days including PRBC, PLT, FFP, fibrinogen concentrate, PCCs, rFVIIa | Day 0-Day 2, |
| Perioperative biological hemostasis | Coagulation tests (PT, aPTT, fibrinogen level) preoperatively, at the end of the surgery (+ thrombin time or ACT ), at arrival in ICU and at POD1, 3 and 5 | Pre-inclusion - Day 5 |
| Complete blood count | Complete blood count preoperatively, at the end of the surgery, at arrival in ICU and at POD1, 3 and 5. | Pre-inclusion - Day 5 |
| ICU and hospital length of stay | calculated ICU and hospital free days | End of study or early termination- Day 30 |
| Early postoperative morbidity within 30 postoperative days | Cardiovascular: need for inotropes and/or vasopressors intravenous infusion >24 hours, need for short-term mechanical circulatory support, occurrence of atrial fibrillation and/or ventricular fibrillation/tachycardia, high grade atrioventricular bloc, myocardial infarction, tamponade, symptomatic thromboembolic events. Respiratory: duration of mechanical ventilation, re-intubation, ARDS according the Berlin criteria, need for VV ECMO Renal: Kidney Disease Improving Global Outcomes stage (KDIGO) ≥2; need for renal replacement therapy. Serum electrolytes and renal function preoperatively, at arrival in ICU and at POD1, 3 and 5. Neurology: transient and permanent stroke, epilepsy, confusion Infectious: mediastinitis, septic shock, pneumopathy and bacteremia Abdominal: mesenteric ischemia, upper and/or lower gastrointestinal bleeding. Liver function tests preoperatively, at arrival in ICU and at POD1, 3 and 5. 30-day all-cause mortality | Day 30 |
| Day 30 /+2 days |
| Haemoglobin and plasma free haemoglobin | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post treatment) during the first two processing cycles. - Laboratory analyses: haemoglobin level and plasma free haemoglobin will be performed Blood samples will be also collected from the patient just before surgery as well as 6+/-2 hours after surgery to measure plasma free haemoglobin level. | just before surgery as well as 6+/-2 hours after surgery |
| Hematocrit | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post treatment) during the first two processing cycles. - Laboratory analyses: hematocrit level will be performed. | During the surgery |
| Complete blood count | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post treatment) during the first two processing cycles. - Laboratory analyses: complete blood count will be performed | During the surgery |
| Unfractionated heparin anti-Xa | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post treatment) during the first two processing cycles. - Laboratory analyses: unfractionated heparin anti-Xa level will be performed | During the surgery |
| Fibrinogen | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post treatment) during the first two processing cycles. - Laboratory analyses: fibrinogen level will be performed | During the surgery |
| Triglycerides | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post treatment) during the first two processing cycles. - Laboratory analyses: triglycerides level will be performed | During the surgery |
| Total proteins | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post treatment) during the first two processing cycles. - Laboratory analyses: total proteins level will be performed | During the surgery |
| Potassium | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post treatment) during the first two processing cycles. - Laboratory analyses: potassium level will be performed | During the surgery |
| Blood viscoelasticity assessment | Patients in whom the salvaged blood from mediastinal shed and residual cardiopulmonary bypass circuit volume will be processed and not reinfused before protamine infusion will be included in this ancillary study. Blood samples will be collected from the patient just before and immediately after re-infusion of the processed blood and sent to the haematology laboratory to perform viscoelasticity assessment Quantra QPlus™ | just before and immediately after re-infusion, pré-treatment and just after traitement by the autotransfusion device |
| Complete bloof count | Patients in whom the salvaged blood from mediastinal shed and residual cardiopulmonary bypass circuit volume will be processed and not reinfused before protamine infusion will be included in this ancillary study. Blood samples will be collected from the patient just before and immediately after re-infusion of the processed blood and sent to the haematology laboratory to complete blood count. | just before and immediately after re-infusion, pré-treatment and just after traitement by the autotransfusion device |
| INF-γ profiling by mass cytometry CyTOF | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post-treatment) during the first cycle of processing for immunology assessment (immune profiling by mass cytometry CyTOF). Blood samples will be also collected from the patient for INF-γ assessment (by mass cytometry CyTOF) immediately just before surgery as well as one day after surgery | just before surgery, one day after surgery, pré-treatment and just after treatment by the autotransfusion device |
| IL-1β-γ profiling by mass cytometry CyTOF | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post-treatment) during the first cycle of processing for immunology assessment (immune profiling by mass cytometry CyTOF). Blood samples will be also collected from the patient for IL-1β assessment (by mass cytometry CyTOF) immediately just before surgery as well as one day after surgery | just before surgery, one day after surgery, pré-treatment and just after treatment by the autotransfusion device |
| Il-6 profiling by mass cytometry CyTOF | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post-treatment) during the first cycle of processing for immunology assessment (immune profiling by mass cytometry CyTOF). Blood samples will be also collected from the patient for Il-6 assessment (by mass cytometry CyTOF) immediately just before surgery as well as one day after surgery | just before surgery, one day after surgery, pré-treatment and just after treatment by the autotransfusion device |
| IL-8 profiling by mass cytometry CyTOF | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post-treatment) during the first cycle of processing for immunology assessment (immune profiling by mass cytometry CyTOF). Blood samples will be also collected from the patient for IL-8 assessment (by mass cytometry CyTOF) immediately just before surgery as well as one day after surgery | just before surgery, one day after surgery, pré-treatment and just after treatment by the autotransfusion device |
| IL-10 profiling by mass cytometry CyTOF | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post-treatment) during the first cycle of processing for immunology assessment (immune profiling by mass cytometry CyTOF). Blood samples will be also collected from the patient for IL-10 assessment (by mass cytometry CyTOF) immediately just before surgery as well as one day after surgery | just before surgery, one day after surgery, pré-treatment and just after treatment by the autotransfusion device |
| TNFα profiling by mass cytometry CyTOF | Blood samples will be collected from the collection reservoir (pre-treatment) of the autotransfusion device and from the reinfusion bag (post-treatment) during the first cycle of processing for immunology assessment (immune profiling by mass cytometry CyTOF). Blood samples will be also collected from the patient for TNFα assessment (by mass cytometry CyTOF) immediately just before surgery as well as one day after surgery | just before surgery, one day after surgery, pré-treatment and just after treatment by the autotransfusion device |
| HOSPICES CIVILS DE LYON, Hôpital Louis Pradel, Service Anesthésie Réanimation | Not yet recruiting | Bron | 69677 | France |
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| CHU MONTPELLIER, Hôpital Arnaud de Villeneuve, Service Anesthésie Réanimation Arnaud de Villeneuve | Recruiting | Montpellier | 34295 | France |
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| CHU Nantes, Service Anesthésie Réanimation de chirurgie cardiaque | Recruiting | Nantes | 44093 | France |
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| Groupe Hospitalier Pitié Salpêtrière, APHP, Service Anesthésie Réanimation chirurgicale | Not yet recruiting | Paris | 75651 | France |
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| Hôpital Bichat-Claude Bernard, APHP, Service Anesthésie Réanimation | Not yet recruiting | Paris | 75877 | France |
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| Hôpital Européen Georges Pompidou, AP-HP, Service Anesthésie Réanimation | Not yet recruiting | Paris | 75908 | France |
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| CHU Rennes, Hôpital Pontchaillou, Service Anesthésie Réanimation 3-Réanimation CTCV | Recruiting | Rennes | 35033 | France |
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| CHRU STRASBOURG, Nouvel Hôpital Civil, Service Anesthésie Réanimation chirurgicale | Recruiting | Strasbourg | 67091 | France |
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| CHU Toulouse, Hôpital Rangueil, Service Anesthésie | Not yet recruiting | Toulouse | 31400 | France |
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