Patient Blood Management in Patients Scheduled for Cardiac Surgery
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Iron.
- Who it may be relevant to
- Registry conditions: Anemia, Anemia, Iron-Deficiency, Iron Deficiency Anemia Treatment, Iron Deficiency Anemia (IDA). Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Italy
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Official title
Patient Blood Management in Cardiac Surgical Patients: the ICARUS-2 Study
Overview
The ICARUS 2 study has the general objective of collecting data in patients undergoing cardiac surgery; in our centre, in order to optimize and improve hemoglobin values, a team of haematologists, assisted by cardio anesthetists and cardiac surgeons, will evaluate the blood tests of patients scheduled for elective cardiac surgery in order to correct any states of hypoferritinemia (low iron in the blood) to promote recovery from blood losses related to cardiac surgery. This objective is strongly encouraged by the good use of blood programs currently in force at our foundation. In particular, the research presented here intends to demonstrate a reduction in the number of intra- and post-operative transfusions.
Detailed description
A significant percentage of patients schduled for cardiac surgery have an absolute or relative iron deficiency (ID) with or without anemia. Preoperative outpatient treatment of anemia and iron deficiency is one of the pillars of patient blood management (PBM). Data collected at our institution show that 35% of patients undergoing cardiac surgery at the Foundation receive 2 or more units of concentrated red blood cells at surgery or in the following 7 days. A recently published ambispective study (ICARUS) demonstrated that intravenous iron supplementation, even in the immediate pre-operative period (i.e 1 or 2 days), reduces the number of post-operative transfusions and the length of hospital stay. Similar results were recently obtained by other authors in a randomized study. Assuming the correction of ID at an earlier stage, the haematological outcome could be significantly better, with a reduction in the percentage of patients transfused and in the average transfusion requirement, increase in haemoglobin levels at discharge, improvement in clinical conditions and possible further reduction of the length of stay. All this could translate into a further reduction in costs related to the intervention.
The study is observational and involves the early application of the PBM program based on good clinical practice which includes the correction of absolute or relative ID. This deficiency will be treated at least 2 weeks before the planned cardiac surgery: the patient will receive an i.v. of iron in the clinic, in accordance with the indications, doses and route of administration for which the use of the drug is approved and the drug distributed on the market. At the same time as iron administration, vitamin supplementation will be prescribed (Vitamin B12 1 mg total subcutaneously) and oral folic acid (5 mg/day).
Interventions
- Drug Iron
Patients who present a state of hypoferritinemia or a state of reduced transferrin saturation will undergo administration of i.v iron at least 2 weeks before scheduled cardiac surgery, plus acid folic and B vitamin co-administration.
Primary outcome measures
- Percentage of patients receiving RBC transfusion within post-operative day 7 [Time frame: within post operative day 7]
Secondary outcome measures (6)
- cost measured in euros for the IDA treatment and blood product consumption [Time frame: from enrollment to 1 week after surgery]
- Hb values at last postoperative control within 7 days from surgery [Time frame: within post operative day 7]
- ICU lenght of stay [Time frame: through study completion, an average of 2 year]
- Number of allogenic blood products administered [Time frame: within the first 7 days post operative]
- mortality [Time frame: from surgery within post operative day 7]
- Hospital Lenght of Stay [Time frame: through study completion, an average of 2 year]
Eligibility criteria
Inclusion criteria
\- all adult patients scheduled for elective cardiac surgery
Exclusion criteria
- pregnancy
- dyalisis
- patient's refusal
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Case-control
Study locations
Italy · 1 center
- Fondazione Policlinico Gemelli IRCCS — Roma
Publications
- Corsi F, Pasquini A, Guerrera M, Bevilacqua F, Taccheri T, Antoniucci ME, Calabrese M, Valentini CG, Orlando N, Bartolo M, Cannetti G, Pellegrino C, Cavaliere F, Teofili L. Single shot of intravenous iron in cardiac surgery: The ICARUS study. J Clin Anesth. 2023 Feb;84:111009. doi: 10.1016/j.jclinane.2022.111009. Epub 2022 Nov 16. PMID 36401886
Identifiers
NCT: NCT06637137 · 6727/2024 · FPG gemelli IRCCS