E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Hypovolaemia due to acute blood loss in trauma surgery |
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E.1.1.1 | Medical condition in easily understood language |
Decreased blood volume due to acute blood loss in trauma patients |
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E.1.1.2 | Therapeutic area | Diseases [C] - Injuries, poisonings, and occupational diseases [C21] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10021137 |
E.1.2 | Term | Hypovolaemia |
E.1.2 | System Organ Class | 10027433 - Metabolism and nutrition disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Investigate the safety of a 6% HES solution versus an electrolyte solution in trauma patients |
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E.2.2 | Secondary objectives of the trial |
Further investigation of safety and efficacy of the applied products |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Male or female adult patients ≥ 18 and ≤ 80 years of age
Women of childbearing potential must test negative on standard pregnancy test (urine or serum)
Patients with blunt or penetrating trauma suffering from an estimated blood loss of ≥ 500 ml
Initial surgery deemed necessary within 24 hours after trauma
Deferred signed written informed consent form or as locally required
No signs of intracranial or cerebral haemorrhage
Base excess < - 4 mEq/l
Administration of less than 15 ml/kg body weight colloid between trauma injury and hospital admission |
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E.4 | Principal exclusion criteria |
Hypersensitivity to the active substances or to any of the other excipients of the investigational products
Body weight ≥ 140 kg
Patients expected to die within 24 hours after traumatic injury
Sepsis
Burns
Renal impairment (AKIN stage ≥ 1) or acute and/or chronic renal replacement therapy
Critically ill patients (typically admitted to the intensive care unit)
Dehydration
Hyperhydration
Pulmonary oedema
Congestive heart failure
Hyperkalaemia
Severe hypernatraemia
Severe hyperchloraemia
Metabolic alkalosis
Severely impaired hepatic function
Severe coagulopathy
Organ transplant patients
Simultaneous participation in another clinical interventional trial (drugs or medical devices) |
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E.5 End points |
E.5.1 | Primary end point(s) |
Composite primary endpoint: 90 day mortality and 90 day renal failure
Mortality: differentiation between in-hospital and out of hospital will be made
Renal failure is defined as biomarker increase as defined by AKIN stage 2 or RIFLE category injury or need for renal replacement therapy (RRT), including haemodialysis, peritoneal dialysis, haemofiltration, and renal transplantation at any time during the first 3 months. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At hospital admission and discharge
At ICU admission and discharge
90 day mortality and renal failure evaluation at day 90 ± 14 days (Timepoint 4 (T4) = 90 days after randomization)
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E.5.2 | Secondary end point(s) |
Safety
- Renal function: Serum creatinine (SCr), Cystatin-C, SCr based eGFR, Cystatin-C based estimated glomerular filtration rate (eGFR), Cystatin-C based mean eGFR, AKIN stage, highest AKIN on each day (during the first week), RIFLE category, urine output (if available)
- Coagulation: Platelet count, International norm ratio (INR), activated partial thromboplastin time (aPTT)
- Inflammation: C-reactive protein (C-RP)
- Adverse events: (serious) adverse events ((S)AEs / reactions ((S)ARs)
- Outcome: Length of stay (LOS) in the hospital (LOS-H), LOS in the intensive care unit (LOS-ICU); fit for discharge from ICU / hospital, need for mechanical ventilation / duration of mechanical ventilation (MV), Mortality (in-hospital / out of hospital) and its cause, need for renal replacement therapy (RRT) / duration of RRT
Efficacy
- Fluid administration: administration of IP volume
- Fluid balance: fluid input and output
- Haemodynamics / vital signs: Temperature (T), heart rate (HR), mean arterial pressure (MAP, calculated), systolic arterial blood pressure (SAP), diastolic arterial blood pressure (DAP), central venous pressure (CVP, if available)
- and at least one of the following parameters to evaluate responsiveness and guide administration (vol guide): stroke volume (SV), stroke volume variation (SVV), stroke volume index (SVI), pulse pressure variation (PPV), mean arterial pressure (measured)
Arterial Blood Gas Analysis (ABGA): partial pressure of carbondioxide (pCO2), partial pressure of oxygen (pO2), hydrogen carbonate (HCO3-), arterial oxygen saturation (SaO2), haemoglobin (Hb), haematocrit (Hct), pH, base excess (BE), lactate
centralvenous oxygen saturation (ScvO2)
Serum electrolytes (S elyte): Sodium, potassium, calcium, chloride
Definition of time-points
Screening (at hospital admission)
T0 (Baseline, emergency room)
T1 (first 24 hours after randomization)
T2 (post-traumatic day 1-3)
T3 (post-traumatic day 4-7)
T4 (day 90 after randomization) ± 14 days |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
SCr & SCr-based eGFR : T0, T1 (every 6 hours), T2, T3
Cystatin-C: T0, T1 (every 6 hours), T2
Cystatin-C-based eGFR: T0
Cystatin-C-based mean eGFR: T1, T2
AKIN stage: T0, T1 (every 6 hours), T2, T3
highest AKIN stage: T1, T2, T3
RIFLE category: T0, T1 (every 6 hours), T2, T3
Urin output: T0, T1 (every 6 hours), T2, T3
Coagulation: T0, T1 (every 6 hours), T2, T3
C-RP: T0, T1 (every 6 hours), T2, T3
(S)AEs/(S)ARs: T0-T4
LOS-H, LOS-ICU, Fit for discharge - H & ICU: daily
MV: screening - T3
Mortality: T1-T4
RRT : T1-T4
IP intake, fluid in-/output, fluid bal: T0-T3
T: T0-T3
HR, MAP, SAP, DAP, CVP: T0, T1 (every 6 hours), T2, T3
vol guide: during IP admin
ABGA: T0, T1 (every 6 hours), T2, T3
ScvO2: T0, T1 (every 6 hours), T2, T3
S Elyte: T0, T1 (every 6 hours), T2, T3 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 25 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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T4, i.e. day 90 ± 14 days of the last patient |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |