IVC CLAMP: infrahepatic inferior vena cava clamping during hepatectomy--a randomised controlled trial in an interdisciplinary setting.
BACKGROUND
Intraoperative haemorrhage is a known predictor for perioperative outcome of patients undergoing hepatic resection. While anaesthesiological lowering of central venous pressure (CVP) by fluid restriction is known to reduce bleeding during transection of the hepatic parenchyma its potential side effects remain poorly investigated. In theory it may have negative effects on kidney function and tissue perfusion and bears the risk to result in severe haemodynamic instability in case of profound intraoperative blood loss. The present randomised controlled trial evaluates efficacy and safety of infrahepatic inferior vena cava (IVC) clamping as an alternative surgical technique to reduce CVP during hepatic resection.


METHODS
The proposed IVC CLAMP trial is a single-centre randomised controlled trial with a two-group parallel design. Patients and outcome-assessors are blinded for the treatment intervention. Patients undergoing elective hepatic resection due to any reason are enrolled in IVC CLAMP. All patients admitted to the Department of General-, Visceral-, and Transplant Surgery, University of Heidelberg for elective hepatic resection are consecutively screened for eligibility and written informed consent is obtained on the day before surgery. The primary objective of this trial is to assess and compare the amount of blood loss during hepatic resection in patients receiving surgical CVP reduction by clamping of the IVC as compared to anaesthesiological CVP without infrahepatic IVC clamping reduction. In addition to blood loss a set of general as well as surgical variables are analysed.


CONCLUSIONS
This is a randomised controlled patient and observer blinded two-group parallel trial designed to assess efficacy and safety of infrahepatic IVC clamping during elective hepatectomy.
Rahbari
Nuh N
NN
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Germany. nuh.rahbari@med.uni-heidelberg.de
Zimmermann
Johannes B
JB
Koch
Moritz
M
Bruckner
Thomas
T
Schmidt
Thomas
T
Elbers
Heike
H
Reissfelder
Christoph
C
Weigand
Markus A
MA
Büchler
Markus W
MW
Weitz
Jürgen
J
D002496:Central Venous Pressure; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care; D011300:Preoperative Care; D012107:Research Design; D018401:Sample Size; D014682:Vena Cava, Inferior / Q000601:surgery*