Empiric Calcium in Massive Transfusion
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ClinicalTrials.gov Identifier: NCT05953376 |
Recruitment Status :
Not yet recruiting
First Posted : July 20, 2023
Last Update Posted : April 8, 2024
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Condition or disease | Intervention/treatment | Phase |
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Hemorrhage Trauma Hypocalcemia Shock, Hemorrhagic | Drug: Calcium Gluconate | Phase 3 |
Advancements in the area of transfusion and blood product administration have occurred with the use of viscoelastic assays and whole blood. However, as we resuscitate trauma patients with blood products, hypocalcemia is an inadvertent side-effect. Citrate within stored blood binds calcium, causing patients to have hypocalcemia. In addition, outside of transfusion related hypocalcemia there is an independent trauma/inflammation related mechanism for hypocalcemia in the trauma patient. Furthermore, Calcium is a critical component of the coagulation cascade, and therefore a highly important component of hemostatic resuscitation. Hall et al found that patients receiving 13 or more units of PRBCs had a much higher prevalence of severe hypocalcemia and at least one ionized calcium <1.0mmol/L. Kronstedt el al reported an association between hypocalcemia and mortality in trauma patients receiving massive transfusion. Despite evidence that hypocalcemia occurs with transfusion, and evidence that hypocalcemia in patients with hemorrhagic shock may be associated with increased mortality, there are no randomized controlled trials evaluating the administration of calcium in trauma resuscitation. Currently, the Joint Trauma System revised guidelines for damage control resuscitation from 2019 recommend administering 1g of calcium after the first unit of blood transfusion, and an additional 1g after no more than 4 units of blood administration. However, these recommendations are based on small cohort studies or retrospective studies. The purpose of this study is to evaluate the efficacy of early empiric intravenous calcium administration on transfusion requirements, vasopressor use and mortality in hemorrhaging trauma patients with initiation of a massive transfusion.
All trauma patients in which massive transfusion is initiated within 6 hours of arrival will be enrolled. Two study arms will be created, one will receive 2g IV calcium with the initial transfusion and the other will only receive calcium supplementation based on routine ionized calcium levels and/or physician discretion. All critical trauma activations will get a baseline ionized calcium as part of their initial labs.
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 30 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Triple (Participant, Care Provider, Investigator) |
Primary Purpose: | Treatment |
Official Title: | Empiric Calcium Versus Lab Based Treatment in Massive Transfusion Trauma Patients: A Feasibility Randomized Controlled Trial |
Estimated Study Start Date : | January 2025 |
Estimated Primary Completion Date : | December 2025 |
Estimated Study Completion Date : | December 2026 |
Arm | Intervention/treatment |
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Experimental: Empiric calcium administration
Patients in this arm will receive 2g IV calcium with the initial transfusion
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Drug: Calcium Gluconate
There will be 2 study arms, one will receive 2g IV calcium with the initial transfusion and the other will only receive calcium supplementation based on routine ionized calcium levels and/or physician discretion.
Other Name: Calcium |
No Intervention: No empiric calcium administration
Patients in this arm will only receive calcium supplementation based on routine ionized calcium levels and/or physician discretion
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- Transfusion requirements [ Time Frame: During first 24 hours of resuscitation ]Number of packed red blood cells, whole blood, fresh frozen plasma, platelets and cryo units given
- Mortality [ Time Frame: 30-day mortality ]30-day mortality or until discharge (whichever is longer)
- Vasopressor use [ Time Frame: During first 24 hours of resuscitation ]Amount of vasopressor used within the first 24 hours measured in levophed equivalents
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Trauma patients receiving massive transfusion protocol
Exclusion Criteria:
- Pregnancy
- Prisoners
- Known history of hypercalcemia
- Active hyperparathyroidism
- Hemophilia
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05953376
Contact: Jeffry Nahmias, MD | 714-456-5890 | jnahmias@hs.uci.edu | |
Contact: Mallory Jebbia, MD | 714-456-5860 | mjebbia@hs.uci.edu |
Principal Investigator: | Jeffry Nahmias, MD | University of California, Irvine |
Responsible Party: | Jeffrey Nahmias, MD, Associate Professor of Surgery, University of California, Irvine |
ClinicalTrials.gov Identifier: | NCT05953376 |
Other Study ID Numbers: |
3115 |
First Posted: | July 20, 2023 Key Record Dates |
Last Update Posted: | April 8, 2024 |
Last Verified: | April 2024 |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Product Manufactured in and Exported from the U.S.: | Yes |
Hypocalcemia Hemorrhage Shock, Hemorrhagic Pathologic Processes Calcium Metabolism Disorders Metabolic Diseases Water-Electrolyte Imbalance |
Shock Calcium, Dietary Calcium Calcium-Regulating Hormones and Agents Physiological Effects of Drugs Bone Density Conservation Agents |