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出境医 / 临床实验 / The PATHFINDER Study: A Feasibility Trial (PATHFINDER)

The PATHFINDER Study: A Feasibility Trial (PATHFINDER)

Study Description
Brief Summary:
The main purpose of this study is to determine whether a rational strategy of EEG guided multimodal general anesthesia using target specific sedative and analgesics could result in enhanced recovery after anesthesia and surgery, decrease in postoperative delirium, and decrease in long term postoperative cognitive dysfunction up to 6 months following cardiac surgery.

Condition or disease Intervention/treatment Phase
Coronary Artery Disease Delirium Drug: Ropivacaine Drug: Ketamine Drug: Remifentanil Drug: Dexmedetomidine Drug: Rocuronium Drug: Propofol Drug: Sevoflurane Device: EEG monitoring Early Phase 1

Detailed Description:

The main purpose of this study is to determine whether a rational strategy of EEG guided multimodal general anesthesia using target specific sedative and analgesics could result in enhanced recovery after anesthesia and surgery, decrease in postoperative delirium, and decrease in long term postoperative cognitive dysfunction up to 6 months following cardiac surgery.

Specific Aim 1: The feasibility of implementing multimodal general anesthesia strategy in the Operating Rooms (OR) Specific Aim 2: The feasibility of implementing EEG guided sedation until extubation in the Intensive Care Unit (ICU) Specific Aim 3: The enhancement of recovery after surgery (shorter ventilation time, ICU stay, hospital length of stay) Specific Aim 4: To estimate the effect size of decrease in postoperative day (POD) and postoperative cognitive dysfunction (POCD) to power future large randomized trials

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 22 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Intervention Model Description: 2 roll-in patients followed by 20 patients in the interventional model.
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Perioperative Multimodal General Anesthesia Focusing on Specific CNS Targets in Patients Undergoing Cardiac Surgeries
Actual Study Start Date : August 20, 2019
Actual Primary Completion Date : February 19, 2020
Actual Study Completion Date : July 7, 2020
Arms and Interventions
Arm Intervention/treatment
Experimental: Multimodal General Anesthesia

Intraoperative

The anesthesiologists involved in this study will be trained to infer differences in anti-nociception, unconsciousness movement and changes during other perioperative events by monitoring EEG. They will also be trained in titrating hypnotic and nociceptic medications based on changes in EEG.

  1. Routine anesthetic induction
  2. Bilateral Pectoro-interfascial block (PIFB) with 20 mL of 0.25% ropivacaine on either side of the sternum after anesthetic induction but before surgical incision
  3. Ketamine (0.06 to 0.12 mg.kg/hr)
  4. Remifentanil (0.05-0.2 mcg/kg/min)
  5. Dexmedetomidine (0.2-1.0 mcg/kg/hr)
  6. Rocuronium intermittent bolus (TOF)
  7. Propofol infusion ± Sevoflurane titrated based on EEG monitoring

Postoperative

  1. Standard pain management protocol
  2. Dexmedetomidine infusion 0.2-1.4 mcg/kg/hr (EEG guided)
  3. Infusion continued till extubation
  4. Propofol infusion may be added/used for sedation based on the treating physician's discretion
 Drug: Ropivacaine
Intraoperative bilateral PIFB block with 20 mL of 0.25% Ropivicaine on either side of the sternum after anesthetic induction but before surgical incision

Drug: Ketamine
Intraoperative infusion

Drug: Remifentanil
Intraoperative infusion

Drug: Dexmedetomidine
Intraoperative infusion

Drug: Rocuronium
Intraoperative intermittent bolus

Drug: Propofol
Intraoperative infusion

Drug: Sevoflurane
Intraoperative inhaled as needed

Drug: Dexmedetomidine
Post-operative infusion

Drug: Propofol
Post-operative infusion

Device: EEG monitoring
Perioperative monitoring
Standard Practice with EEG monitoring
The initial 2 patients will receive standard anesthesia practice and perioperative EEG monitoring will be recorded to learn the patterns associated with our standard practice.
 Device: EEG monitoring
Perioperative monitoring
Outcome Measures
Primary Outcome Measures :
  1. Incidence of Delirium [ Time Frame: Participants will be followed for the duration of the hospital stay, an average of 5 days ]
    Incidence of delirium will be analyzed in patients treated with the multi-modal approach. Delirium will be defined as an acute change in pre-operative baseline condition with additional features of inattention and either disorganized thinking and altered loss of consciousness, as defined by the Confusion Assessment Method (CAM)Assessment Method (CAM) algorithm postoperatively until discharge.


Secondary Outcome Measures :
  1. Time to extubation [ Time Frame: Time of ICU admission until time of extubation in ICU, an average of 6 hours ]
    Time to extubation will be noted from ICU data

  2. Montreal Cognitive Assessment (MoCA) [ Time Frame: On the day of discharge, an average of 6 days ]
    MoCA scores (total possible score is 30 points; a score of 26 or above is considered normal) at discharge will be reported in order to assess the occurrence of postoperative cognitive decline. Study staff trained in administering the assessments will collect the data.

  3. Pain scores [ Time Frame: At 4-8 hourly intervals every day until discharge, an average of 6 days ]
    Patient reported pain scores on a scale from 0-10 (0 no pain,10 extreme pain), until discharge for the index admission.

  4. Total opioid and supplemental analgesic consumption [ Time Frame: 48 hours, post-operative ]
    The total opioid dosage and supplemental analgesic dosage received in the first 48 hours postoperatively will be abstracted from the medical record.

  5. ICU [ Time Frame: Time of ICU admission until time of discharge to hospital floor; through the hospital stay, an average of 5 days ]
    Total duration of stay in ICU for the index admission

  6. ICU/hospital length of stay [ Time Frame: Time of stay in the hospital until discharge to floor or rehab, an average of 5 days ]
    Their stay in the hospital for the index admission

  7. In-hospital complications [ Time Frame: 7 days post-op on an average ]
    stroke, myocardial infarction (MI), acute kidney injury, pneumonia, reintubation, congestive heart failure, sepsis, reopening of sternum and all-cause mortality

  8. Follow up incidence of delirium [ Time Frame: Patients will be assessed for delirium at 1 month and 6 months following the date of surgery ]
    The follow up incidence of delirium will be analyzed at 1 month and 6 months after discharge. Delirium will be defined as an acute change in pre-operative baseline condition with additional features of inattention and either disorganized thinking and altered loss of consciousness, as defined by the MoCA/t-MoCA.


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   60 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age ≥ 60 years
  2. Undergoing any of the following types of surgery with cardiopulmonary bypass limited to coronary artery bypass surgery (CABG), CABG+valve surgeries and isolated valve surgeries.

Exclusion Criteria:

  1. Preoperative left ventricular ejection fraction (LVEF) <30%
  2. Emergent surgery
  3. Non-English speaking
  4. Cognitive impairment as defined by total MoCA score < 10
  5. Currently enrolled in another interventional study that could impact the primary outcome, as determined by the PI
  6. Significant visual impairment
  7. Chronic opioid use for chronic pain conditions with tolerance (total dose of an opioid at or more than 30 mg morphine equivalent for more than one month within the past year)
  8. Hypersensitivity to any of the study medications
  9. Known history of alcohol (> 2 drinks per day) or drug abuse Active (in the past year) history of alcohol abuse (≥5 drinks/day for men or ≥4 drinks/day for women) as determined by reviewing medical record and history given by the patient
  10. Liver dysfunction (liver enzymes > 4 times the baseline, all patients will have a baseline liver function test evaluation), history and examination suggestive of jaundice.
Contacts and Locations

Locations
Layout table for location information
United States, Massachusetts
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States, 02215
Sponsors and Collaborators
Beth Israel Deaconess Medical Center
Investigators
Layout table for investigator information
Principal Investigator: Balachundhar Subramaniam, MD, MPH Beth Israel Deaconess Medical Center
Tracking Information
First Submitted Date  ICMJE July 9, 2019
First Posted Date  ICMJE July 11, 2019
Last Update Posted Date January 28, 2021
Actual Study Start Date  ICMJE August 20, 2019
Actual Primary Completion Date February 19, 2020   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: July 10, 2019) 		Incidence of Delirium [ Time Frame: Participants will be followed for the duration of the hospital stay, an average of 5 days ]
Incidence of delirium will be analyzed in patients treated with the multi-modal approach. Delirium will be defined as an acute change in pre-operative baseline condition with additional features of inattention and either disorganized thinking and altered loss of consciousness, as defined by the Confusion Assessment Method (CAM)Assessment Method (CAM) algorithm postoperatively until discharge.
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: July 10, 2019)
  • Time to extubation [ Time Frame: Time of ICU admission until time of extubation in ICU, an average of 6 hours ]
    Time to extubation will be noted from ICU data
  • Montreal Cognitive Assessment (MoCA) [ Time Frame: On the day of discharge, an average of 6 days ]
    MoCA scores (total possible score is 30 points; a score of 26 or above is considered normal) at discharge will be reported in order to assess the occurrence of postoperative cognitive decline. Study staff trained in administering the assessments will collect the data.
  • Pain scores [ Time Frame: At 4-8 hourly intervals every day until discharge, an average of 6 days ]
    Patient reported pain scores on a scale from 0-10 (0 no pain,10 extreme pain), until discharge for the index admission.
  • Total opioid and supplemental analgesic consumption [ Time Frame: 48 hours, post-operative ]
    The total opioid dosage and supplemental analgesic dosage received in the first 48 hours postoperatively will be abstracted from the medical record.
  • ICU [ Time Frame: Time of ICU admission until time of discharge to hospital floor; through the hospital stay, an average of 5 days ]
    Total duration of stay in ICU for the index admission
  • ICU/hospital length of stay [ Time Frame: Time of stay in the hospital until discharge to floor or rehab, an average of 5 days ]
    Their stay in the hospital for the index admission
  • In-hospital complications [ Time Frame: 7 days post-op on an average ]
    stroke, myocardial infarction (MI), acute kidney injury, pneumonia, reintubation, congestive heart failure, sepsis, reopening of sternum and all-cause mortality
  • Follow up incidence of delirium [ Time Frame: Patients will be assessed for delirium at 1 month and 6 months following the date of surgery ]
    The follow up incidence of delirium will be analyzed at 1 month and 6 months after discharge. Delirium will be defined as an acute change in pre-operative baseline condition with additional features of inattention and either disorganized thinking and altered loss of consciousness, as defined by the MoCA/t-MoCA.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE The PATHFINDER Study: A Feasibility Trial
Official Title  ICMJE Perioperative Multimodal General Anesthesia Focusing on Specific CNS Targets in Patients Undergoing Cardiac Surgeries
Brief Summary The main purpose of this study is to determine whether a rational strategy of EEG guided multimodal general anesthesia using target specific sedative and analgesics could result in enhanced recovery after anesthesia and surgery, decrease in postoperative delirium, and decrease in long term postoperative cognitive dysfunction up to 6 months following cardiac surgery.
Detailed Description

The main purpose of this study is to determine whether a rational strategy of EEG guided multimodal general anesthesia using target specific sedative and analgesics could result in enhanced recovery after anesthesia and surgery, decrease in postoperative delirium, and decrease in long term postoperative cognitive dysfunction up to 6 months following cardiac surgery.

Specific Aim 1: The feasibility of implementing multimodal general anesthesia strategy in the Operating Rooms (OR) Specific Aim 2: The feasibility of implementing EEG guided sedation until extubation in the Intensive Care Unit (ICU) Specific Aim 3: The enhancement of recovery after surgery (shorter ventilation time, ICU stay, hospital length of stay) Specific Aim 4: To estimate the effect size of decrease in postoperative day (POD) and postoperative cognitive dysfunction (POCD) to power future large randomized trials
Study Type  ICMJE Interventional
Study Phase  ICMJE Early Phase 1
Study Design  ICMJE Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Intervention Model Description:
2 roll-in patients followed by 20 patients in the interventional model.
Masking: None (Open Label)
Primary Purpose: Other
Condition  ICMJE
  • Coronary Artery Disease
  • Delirium
Intervention  ICMJE
  • Drug: Ropivacaine
    Intraoperative bilateral PIFB block with 20 mL of 0.25% Ropivicaine on either side of the sternum after anesthetic induction but before surgical incision
  • Drug: Ketamine
    Intraoperative infusion
  • Drug: Remifentanil
    Intraoperative infusion
  • Drug: Dexmedetomidine
    Intraoperative infusion
  • Drug: Rocuronium
    Intraoperative intermittent bolus
  • Drug: Propofol
    Intraoperative infusion
  • Drug: Sevoflurane
    Intraoperative inhaled as needed
  • Drug: Dexmedetomidine
    Post-operative infusion
  • Drug: Propofol
    Post-operative infusion
  • Device: EEG monitoring
    Perioperative monitoring
Study Arms  ICMJE
  • Experimental: Multimodal General Anesthesia

    Intraoperative

    The anesthesiologists involved in this study will be trained to infer differences in anti-nociception, unconsciousness movement and changes during other perioperative events by monitoring EEG. They will also be trained in titrating hypnotic and nociceptic medications based on changes in EEG.

    1. Routine anesthetic induction
    2. Bilateral Pectoro-interfascial block (PIFB) with 20 mL of 0.25% ropivacaine on either side of the sternum after anesthetic induction but before surgical incision
    3. Ketamine (0.06 to 0.12 mg.kg/hr)
    4. Remifentanil (0.05-0.2 mcg/kg/min)
    5. Dexmedetomidine (0.2-1.0 mcg/kg/hr)
    6. Rocuronium intermittent bolus (TOF)
    7. Propofol infusion ± Sevoflurane titrated based on EEG monitoring

    Postoperative

    1. Standard pain management protocol
    2. Dexmedetomidine infusion 0.2-1.4 mcg/kg/hr (EEG guided)
    3. Infusion continued till extubation
    4. Propofol infusion may be added/used for sedation based on the treating physician's discretion
    Interventions:
    • Drug: Ropivacaine
    • Drug: Ketamine
    • Drug: Remifentanil
    • Drug: Dexmedetomidine
    • Drug: Rocuronium
    • Drug: Propofol
    • Drug: Sevoflurane
    • Drug: Dexmedetomidine
    • Drug: Propofol
    • Device: EEG monitoring
  • Standard Practice with EEG monitoring
    The initial 2 patients will receive standard anesthesia practice and perioperative EEG monitoring will be recorded to learn the patterns associated with our standard practice.
    Intervention: Device: EEG monitoring
Publications *
  • Brown EN, Lydic R, Schiff ND. General anesthesia, sleep, and coma. N Engl J Med. 2010 Dec 30;363(27):2638-50. doi: 10.1056/NEJMra0808281. Review.
  • Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018 Nov;127(5):1246-1258. doi: 10.1213/ANE.0000000000003668. Review.
  • McNicol E, Horowicz-Mehler N, Fisk RA, Bennett K, Gialeli-Goudas M, Chew PW, Lau J, Carr D; Americal Pain Society. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003 Jun;4(5):231-56. Review.
  • Volkow ND, Collins FS. The Role of Science in the Opioid Crisis. N Engl J Med. 2017 Nov 2;377(18):1798. doi: 10.1056/NEJMc1711494.
  • Mulier J. Opioid free general anesthesia: A paradigm shift? Rev Esp Anestesiol Reanim. 2017 Oct;64(8):427-430. doi: 10.1016/j.redar.2017.03.004. Epub 2017 Apr 18. English, Spanish.
  • MacKenzie KK, Britt-Spells AM, Sands LP, Leung JM. Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis. Anesthesiology. 2018 Sep;129(3):417-427. doi: 10.1097/ALN.0000000000002323.
  • Depth of anaesthesia monitors - Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M | Guidance and guidelines | NICE [Internet]. [cited 2018 Dec 24];Available from: https://www.nice.org.uk/guidance/dg6
  • Wildes TS, Mickle AM, Ben Abdallah A, Maybrier HR, Oberhaus J, Budelier TP, Kronzer A, McKinnon SL, Park D, Torres BA, Graetz TJ, Emmert DA, Palanca BJ, Goswami S, Jordan K, Lin N, Fritz BA, Stevens TW, Jacobsohn E, Schmitt EM, Inouye SK, Stark S, Lenze EJ, Avidan MS; ENGAGES Research Group. Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. JAMA. 2019 Feb 5;321(5):473-483. doi: 10.1001/jama.2018.22005.
  • Wilson PT, Spitzer RL. Major changes in psychiatric nomenclature. Reconciling existing psychiatric medical records with the new American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Hosp Community Psychiatry. 1968 Jun;19(6):169-74.
  • Sauër AM, Slooter AJ, Veldhuijzen DS, van Eijk MM, Devlin JW, van Dijk D. Intraoperative dexamethasone and delirium after cardiac surgery: a randomized clinical trial. Anesth Analg. 2014 Nov;119(5):1046-52. doi: 10.1213/ANE.0000000000000248.
  • Rudolph JL, Jones RN, Levkoff SE, Rockett C, Inouye SK, Sellke FW, Khuri SF, Lipsitz LA, Ramlawi B, Levitsky S, Marcantonio ER. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation. 2009 Jan 20;119(2):229-36. doi: 10.1161/CIRCULATIONAHA.108.795260. Epub 2008 Dec 31.
  • Burkhart CS, Dell-Kuster S, Gamberini M, Moeckli A, Grapow M, Filipovic M, Seeberger MD, Monsch AU, Strebel SP, Steiner LA. Modifiable and nonmodifiable risk factors for postoperative delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2010 Aug;24(4):555-9. doi: 10.1053/j.jvca.2010.01.003. Epub 2010 Mar 15.
  • Arora RC, Djaiani G, Rudolph JL. Detection, Prevention, and Management of Delirium in the Critically Ill Cardiac Patient and Patients Who Undergo Cardiac Procedures. Can J Cardiol. 2017 Jan;33(1):80-87. doi: 10.1016/j.cjca.2016.08.020. Epub 2016 Oct 5. Review.
  • Delirium: prevention, diagnosis and management | Guidance and guidelines | NICE [Internet]. [cited 2018 Dec 20];Available from: https://www.nice.org.uk/guidance/cg103
  • Pesonen A, Suojaranta-Ylinen R, Hammarén E, Kontinen VK, Raivio P, Tarkkila P, Rosenberg PH. Pregabalin has an opioid-sparing effect in elderly patients after cardiac surgery: a randomized placebo-controlled trial. Br J Anaesth. 2011 Jun;106(6):873-81. doi: 10.1093/bja/aer083. Epub 2011 Apr 6.
  • Urban MK, Ya Deau JT, Wukovits B, Lipnitsky JY. Ketamine as an adjunct to postoperative pain management in opioid tolerant patients after spinal fusions: a prospective randomized trial. HSS J. 2008 Feb;4(1):62-5. doi: 10.1007/s11420-007-9069-9. Epub 2007 Dec 19.
  • Ballard C, Jones E, Gauge N, Aarsland D, Nilsen OB, Saxby BK, Lowery D, Corbett A, Wesnes K, Katsaiti E, Arden J, Amoako D, Prophet N, Purushothaman B, Green D. Optimised anaesthesia to reduce post operative cognitive decline (POCD) in older patients undergoing elective surgery, a randomised controlled trial. PLoS One. 2012;7(6):e37410. doi: 10.1371/journal.pone.0037410. Epub 2012 Jun 15. Erratum in: PLoS One. 2012;7(9). doi:10.1371/annotation/1cc38e55-23e8-44a5-ac2b-43c7b2a880f9. Amaoko, Derek [corrected to Amoako, Derek]. PLoS One. 2013;8(9). doi:10.1371/annotation/c0569644-bea1-4c38-af9a-75d1168e3142.
  • Chan MT, Cheng BC, Lee TM, Gin T; CODA Trial Group. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013 Jan;25(1):33-42. doi: 10.1097/ANA.0b013e3182712fba.
  • Stoppe C, Fahlenkamp AV, Rex S, Veeck NC, Gozdowsky SC, Schälte G, Autschbach R, Rossaint R, Coburn M. Feasibility and safety of xenon compared with sevoflurane anaesthesia in coronary surgical patients: a randomized controlled pilot study. Br J Anaesth. 2013 Sep;111(3):406-16. doi: 10.1093/bja/aet072. Epub 2013 Apr 11.
  • Lurati Buse GA, Schumacher P, Seeberger E, Studer W, Schuman RM, Fassl J, Kasper J, Filipovic M, Bolliger D, Seeberger MD. Randomized comparison of sevoflurane versus propofol to reduce perioperative myocardial ischemia in patients undergoing noncardiac surgery. Circulation. 2012 Dec 4;126(23):2696-704. doi: 10.1161/CIRCULATIONAHA.112.126144. Epub 2012 Nov 7.
  • Papaioannou A, Fraidakis O, Michaloudis D, Balalis C, Askitopoulou H. The impact of the type of anaesthesia on cognitive status and delirium during the first postoperative days in elderly patients. Eur J Anaesthesiol. 2005 Jul;22(7):492-9.
  • Jia Y, Jin G, Guo S, Gu B, Jin Z, Gao X, Li Z. Fast-track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma. Langenbecks Arch Surg. 2014 Jan;399(1):77-84. doi: 10.1007/s00423-013-1151-9. Epub 2013 Dec 13.
  • Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical Electroencephalography for Anesthesiologists: Part I: Background and Basic Signatures. Anesthesiology. 2015 Oct;123(4):937-60. doi: 10.1097/ALN.0000000000000841. Review.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: July 10, 2019) 		22
Original Estimated Enrollment  ICMJE Same as current
Actual Study Completion Date  ICMJE July 7, 2020
Actual Primary Completion Date February 19, 2020   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  1. Age ≥ 60 years
  2. Undergoing any of the following types of surgery with cardiopulmonary bypass limited to coronary artery bypass surgery (CABG), CABG+valve surgeries and isolated valve surgeries.

Exclusion Criteria:

  1. Preoperative left ventricular ejection fraction (LVEF) <30%
  2. Emergent surgery
  3. Non-English speaking
  4. Cognitive impairment as defined by total MoCA score < 10
  5. Currently enrolled in another interventional study that could impact the primary outcome, as determined by the PI
  6. Significant visual impairment
  7. Chronic opioid use for chronic pain conditions with tolerance (total dose of an opioid at or more than 30 mg morphine equivalent for more than one month within the past year)
  8. Hypersensitivity to any of the study medications
  9. Known history of alcohol (> 2 drinks per day) or drug abuse Active (in the past year) history of alcohol abuse (≥5 drinks/day for men or ≥4 drinks/day for women) as determined by reviewing medical record and history given by the patient
  10. Liver dysfunction (liver enzymes > 4 times the baseline, all patients will have a baseline liver function test evaluation), history and examination suggestive of jaundice.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 60 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04016740
Other Study ID Numbers  ICMJE 2019P000407
Has Data Monitoring Committee No
U.S. FDA-regulated Product
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.: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Balachundhar Subramaniam, Beth Israel Deaconess Medical Center
Study Sponsor  ICMJE Beth Israel Deaconess Medical Center
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Balachundhar Subramaniam, MD, MPH Beth Israel Deaconess Medical Center
PRS Account Beth Israel Deaconess Medical Center
Verification Date January 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP

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