Study protocol and statistical analysis plan for the Early Peritoneal Dialysis in Infants after Cardiac Surgery (EPICS) trial

Siva P Namachivayam; Warwick Butt; Anneke C Grobler; Carmel Delzoppo; Stacey Longstaff; Johnny Millar; Yves d'Udekem; EPICS Study Investigators

doi:10.51893/2022.2.OA9

Study protocol and statistical analysis plan for the Early Peritoneal Dialysis in Infants after Cardiac Surgery (EPICS) trial

Crit Care Resusc. 2023 Oct 19;24(2):188-193. doi: 10.51893/2022.2.OA9. eCollection 2022 Jun 6.

Authors

Siva P Namachivayam^{1

2

3

4}, Warwick Butt^{1

2

4}, Anneke C Grobler^{4

5}, Carmel Delzoppo^{1

2

4}, Stacey Longstaff^{1

2}, Johnny Millar^{1

2

4}, Yves d'Udekem^{4

6}; EPICS Study Investigators

Affiliations

¹ Cardiac Intensive Care Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.
² Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
³ Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
⁴ Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
⁵ Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
⁶ Cardiac Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.

Abstract

Background: Peritoneal dialysis (PD) is a commonly used therapy after infant cardiac surgery. It is unclear whether early PD commenced soon after admission to an intensive care unit (ICU) after cardiac surgery results in better outcomes. Objective: To describe the study protocol and statistical analysis plan for the Early Peritoneal Dialysis in Infants after Cardiac Surgery (EPICS) trial. Design, setting, participants and intervention: The EPICS trial is an open, randomised, two-group, single-centre clinical study of infants ≤ 180 days of age who had cardiac surgery (in Risk-Adjusted Classification for Congenital Heart Surgery version 1 categories 3-6) with cardiopulmonary bypass. Participants will be randomly assigned 1:1 to early PD (treatment group) or no early PD (control group). Those assigned to the treatment group will begin receiving PD soon after ICU admission and continue receiving it for 24 hours. Those in the control group will not receive PD during the first 24 hours. Main outcome measures: The primary outcome is a composite measure consisting of one or more of death, cardiac arrest, emergency chest reopening, and requirement for extracorporeal membrane oxygenation (ECMO) within 90 days. The main secondary outcomes are duration of mechanical ventilation, ICU length of stay, hospital length of stay, vasoactive-inotropic score at 24 hours, and cumulative per cent fluid balance by end of Day 2. At Day 90, events such as mortality, requirement for ECMO, cardiac arrest, chest reopening, volume of packed red blood cell transfusion, postoperative infection, readmission to ICU, renal injury and brain injury will be assessed. Conclusions: The EPICS trial aims to evaluate the role of early PD after infant cardiac surgery in lowering the rate of a composite major outcome. In addition, it will test the effect of early PD on duration of mechanical ventilation, and on ICU and hospital length of stay. Trial registration: ACTRN12617001614381.