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Congenital Heart Disease in ChildrenPhase 2/3NCT05579964

The Role of Dexmedetomidine as Myocardial Protector in Pediatric Cardiac Surgery Total Correction of Tetralogy of Fallot

A Phase 2/3 study testing Dexmedetomidine Hcl 100 Mcg/mL Inj in people with Congenital Heart Disease in Children and Cardiopulmonary Bypass, run by National Cardiovascular Center Harapan Kita Hospital Indonesia at 1 site in Indonesia.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Congenital heart disease (CHD) is the most common congenital abnormality found in newborns with Tetralogy of Fallot (TOF) being the most common cyanotic CHD. Total correction of TOF was performed using a cardiopulmonary bypass (CPB) machine. Read more about this study

Who is it for?
Ages 1 month to 18 years
What is being tested?
Dexmedetomidine Hcl 100 Mcg/mL Inj
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
66 participants
Where
1 siteIndonesia
Study dates
10 Oct 2022to 10 Jun 2023
Phase
Phase 2/3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 month to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • The patient's parents or person in charge is willing to participate in the study
  • Patients with classic TOF undergoing elective total correction cardiac surgery
  • Aged 1 month - 18 years old

Who cannot join

  • The patient experiences a change in the surgical plan from elective to immediate or emergency
  • Patients with preoperative infection characterized by procalcitonin >0.5ng/mL
  • Patients with impaired liver function characterized by an increase in Serum Glutamic Oxaloacetic Transaminase (SGOT)/Serum Glutamic Pyruvic Transaminase (SGPT) more than 1.5 times the upper limit of normal
  • Impaired renal function characterized by creatinine > 2 mg/dL
  • Patients with coagulation disorders characterized by International Normalized Ratio (INR) > 1.5
  • Drop-out Criteria:
Show all 13Show fewer
  • Duration of CPB and/or Aortic cross-clamp time exceeding 120 minutes
  • Surgery requires more than two attempts of CPB
  • Patient fails to wean from CPB
  • Patient requires ECMO (Extracorporeal Membrane Oxygenator) postoperatively
  • Patients with postoperative reperfusion injury characterized by pulmonary hemorrhage
  • Patients with residual lesions in the form of moderate-severe pulmonary stenosis and moderate-severe pulmonary regurgitation.
  • Patient dies on the operating table

Trial locations and contacts

1 site in 1 country.

Indonesia1 site
  • National Cardiovascular Center Harapan Kita Hospital Indonesia

    Jakarta, 11420

Other trials in Indonesia

About this study

Congenital heart disease (CHD) is the most common congenital abnormality found in newborns with Tetralogy of Fallot (TOF) being the most common cyanotic CHD. Total correction of TOF was performed using a cardiopulmonary bypass (CPB) machine. However, the use of CPB has a negative effect that causes inflammation and myocardial injury. Myocardial protection in patients undergoing total correction of TOF surgery is more difficult than other cyanotic CHD due to a hypertrophic right ventricular condition. Dexmedetomidine (DEX) is a selective α-2 adrenergic, which has major effects including hypnosis, sedation, and analgesia as well as cardiovascular effects. The sedation is induced by stimulating the α-2 adrenergic receptor in the locus coeruleus (LC) in the pons cerebri. DEX also increases the level of GABA and Galanin and reduces endogenous norepinephrine. The lower level of endogenous norepinephrine decreases the afterload of the ventricles, increases cardiac output, and reduces myocardial injury as a result. Furthermore, the peripheral effects of DEX can reduce myocardial ischemia-reperfusion (MIR) by inhibiting NF-кB pathway activation and reducing the number of pro-inflammatory cytokines released. Thus, the administration of DEX can prevent myocardial necrosis and apoptosis, also reducing reperfusion injury when using CPB machines. Research related to the effectiveness of administering DEX as a myocardial protector in classic TOF patients undergoing elective total correction cardiac surgery in Indonesia is less reported. The aim of this study is to determine the effectiveness of DEX as myocardial protector in classic TOF patients undergoing elective total correction cardiac surgery.

Read the detailed description

This study is a double blind randomized controlled trial to determine the effectiveness of DEX during CPB as myocardial protection between DEX group and control group. The study population is classic TOF patients who underwent elective total correction cardiac surgery. This study was approved by the research ethical committee (Institutional Review Board) of the National Cardiovascular Center Harapan Kita Jakarta (NCCHK). Before randomization, participants who are eligible based on inclusion and exclusion criterias will be given informed consent. If the guardians of the participants agree, the participants will be included in this research. Sixty-six pediatric participants with classic TOF undergoing elective total correction will be randomly divided into two groups, DEX group and control group. Dexmedetomidine HCl is provided in the form of a liquid injection (Precedex/Kabimidine 200 mcg/2 ml). For the DEX group, DEX was calculated with a priming dose of 0.5 mcg/kg in a 5 ml syringe mixed in priming fluid and 0.25 mcg/kg/hour DEX infusion diluted in 0.9% NaCl 20 ml in a 20 ml syringe administered to the CPB reservoir with an infusion rate of 10 ml/hour. For the control group, the volume of administration of 0.9% NaCl as priming and 0.9% NaCl infusion was given to the CPB machine with adjusted amount and rate same as the DEX group.

We will measure myocardial injury biomarker plasma levels (Troponin I) and cytokines proinflammatory biomarkers plasma level (IL-6) as the primary outcome of myocardial protection. Serum plasma levels of troponin I and IL-6 will be taken 4 times (T1, 5 minutes after induction as baseline level; T2,1 hour after CPB; T3, 6 hours after CPB, and T4, 24 hours after CPB). Secondary outcomes including hemodynamic profile (cardiac output, cardiac index, and systemic vascular resistance, at 5 minute before induction as baseline level, 6 hours, 24 hours, and 48 hours after CPB), serum lactate levels at 5 minutes after induction as baseline level, 1 hour, 6 hours, and 24 hours after CPB, morbidity outcomes (vasoinotropic score at 1 hour, 6 hours, and 24 hours after CPB, length of ventilator use, and length of stay in intensive care).

Being tested
Dexmedetomidine Hcl 100 Mcg/mL Inj, Placebo
Keywords
Dexmedetomidine, Myocardial Protection, Tetralogy of Fallot, Total Correction, Double Blind Randomized Controlled Trial, Cardiopulmonary Bypass
Medical subject headings
Tetralogy of Fallot

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Dexmedetomidine Hcl 100 Mcg/mL InjDrug

    Also called Precedex, Kabimidine

    Priming dose of 0.5 mcg/kg in a 5 ml syringe mixed in priming fluid and 0.25 mcg/kg/hour DEX infusion diluted in 0.9% NaCl 20 ml in a 20 ml syringe administered to the CPB reservoir with an infusion rate of 10 ml/hour

  • PlaceboDrug

    Also called NaCl 0.9%

    Priming dose of NaCl 0.9% in a 5 ml syringe mixed in priming fluid and NaCl 0.9% 20 ml in a 20 ml syringe administered to the CPB reservoir with an infusion rate of 10 ml/hour

Study groups in NCT05579964
Study groupRoleWhat they receive
DEX GroupExperimentalPriming Dexmedetomidine 0.5 mcg/kg, Infusion Dexmedetomidine 0.25 mcg/kg/hour
Receives: Drug: Dexmedetomidine Hcl 100 Mcg/mL Inj
Control GroupPlacebo comparatorNaCl 0.9% with adjusted amount and rate same as the DEX group
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Serum Troponin I at baseline

    Troponin I serum concentration will be measured using ELABSCIENCE E-EL-H0649 reagent (ng/mL)

    Measured: 5 minutes after induction of anesthesia (T1)

  2. Serum Troponin I at 1 hour after cardiopulmonary bypass

    Troponin I serum concentration will be measured using ELABSCIENCE E-EL-H0649 reagent (ng/mL)

    Measured: 1 hour after cardiopulmonary bypass (T2)

  3. Serum Troponin I at 6 hours after cardiopulmonary bypass

    Troponin I serum concentration will be measured using ELABSCIENCE E-EL-H0649 reagent (ng/mL)

    Measured: 6 hours after cardiopulmonary bypass (T3)

  4. Serum Troponin I at 24 hours after cardiopulmonary bypass

    Troponin I serum concentration will be measured using ELABSCIENCE E-EL-H0649 reagent (ng/mL)

    Measured: 24 hours after cardiopulmonary bypass (T4)

  5. Serum IL-6 at baseline

    IL-6 serum concentration will measured using RnD Quantikine D6050 IL-6 reagent (pg/mL)

    Measured: 5 minutes after induction of anesthesia (T1)

  6. Serum IL-6 at 1 hour after cardiopulmonary bypass

    IL-6 serum concentration will measured using RnD Quantikine D6050 IL-6 reagent (pg/mL)

    Measured: 1 hour after cardiopulmonary bypass (T2)

  7. Serum IL-6 at 6 hours after cardiopulmonary bypass

    IL-6 serum concentration will measured using RnD Quantikine D6050 IL-6 reagent (pg/mL)

    Measured: 6 hours after cardiopulmonary bypass (T3)

  8. Serum IL-6 at 24 hours after cardiopulmonary bypass

    IL-6 serum concentration will measured using RnD Quantikine D6050 IL-6 reagent (pg/mL)

    Measured: 24 hours after cardiopulmonary bypass (T4)

Secondary outcomes (8)
  1. Cardiac output

    Cardiac output will be measured using transthoracic echocardiography (L/min)

    Measured: 5 minutes after induction of anesthesia (T1), 6 hours (T3), 24 hours (T4), and 48 hours (T5) after cardiopulmonary bypass

  2. Cardiac Index

    Cardiac index will be measured using transthoracic echocardiography (L/min)

    Measured: 5 minutes after induction of anesthesia (T1), 6 hours (T3), 24 hours (T4), and 48 hours (T5) after cardiopulmonary bypass

  3. Systemic Vascular Resistance (SVR)

    SVR will be measured using transthoracic echocardiography (L/min)

    Measured: 5 minutes after induction of anesthesia (T1), 6 hours (T3), 24 hours (T4), and 48 hours (T5) after cardiopulmonary bypass

  4. Serum Lactate

    Serum lactate will be measured using an enzymatic method with a blood gas analyzer machine (mmol/L)

    Measured: 5 minutes after anesthesia induction (T1), and then 1 hour (T2), 6 hours (T3), and 24 hours (T4) after cardiopulmonary bypass

  5. VIS Score

    Vasoinotropic score will be measured using the VIS formula

    Measured: 1 hour (T2), 6 hours (T3), 24 hours (T4) after cardiopulmonary bypass

  6. Mechanical ventilation time

    Mechanical ventilation time will be measured from the moment the patient arrives at the intensive care unit until the patient is extubated

    Measured: 3 days (or until the patient is extubated)

  7. Length of stay in the intensive care unit

    Length of stay in the intensive care unit will be measured from the moment the patient is admitted to the intensive care unit after the surgery until discharge from intensive care unit

    Measured: 7 days (or until the patient is discharge from intensive care unit)

  8. Mortality

    Mortality will be measured as long as patient is hospitalized until 30 days postoperative

    Measured: 30 days post-operative

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Oct 2022
  2. Study start10 Oct 2022
  3. Primary completion10 Apr 2023
  4. Study completion10 Jun 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
66 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05579964
Sponsor's protocol ID
LB.02.01/Vll/011/KEP011/2022
Other IDs
LB.02.01/Vll/011/KEP011/2022
Status last verified
Aug 2023
First submitted
11 Oct 2022
Last updated
24 Aug 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Dexmedetomidine Hcl 100 Mcg/mL Inj in people with Congenital Heart Disease in Children and Cardiopulmonary Bypass, run by National Cardiovascular Center Harapan Kita Hospital Indonesia at 1 site in Indonesia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 24 Aug 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Indonesia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Serum Troponin I at baseline (time frame: 5 minutes after induction of anesthesia (T1)). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Aug 2023.

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