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Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community- Acquired Pneumonia
Sponsor: UMC Utrecht
Summary
REMAP-CAP is a randomised, embedded, multifactorial, adaptive platform trial for community-acquired pneumonia. The purpose of this study is to evaluate the effect of a range of interventions to improve outcome of patients admitted to intensive care with community-acquired pneumonia. In addition, REMAP-CAP provides and adaptive research platform for evaluation of multiple treatment modalities in the event of a respiratory pandemic such as COVID-19. REMAP-COVID is a sub-platform of REMAP-CAP that evaluates treatments specific to COVID-19 in the United States of America.
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
20000
Start Date
2016-04-11
Completion Date
2028-02
Last Updated
2024-07-12
Healthy Volunteers
No
Interventions
Ceftriaxone
The duration and dose of empiric antibiotics will be determined by the treating clinician and local guidelines or practice.
Moxifloxacin or Levofloxacin
The duration and dose of empiric antibiotics will be determined by the treating clinician and local guidelines or practice.
Piperacillin-tazobactam
The duration and dose of empiric antibiotics will be determined by the treating clinician and local guidelines or practice.
Ceftaroline
The duration and dose of empiric antibiotics will be determined by the treating clinician and local guidelines or practice. Note: this intervention is now closed.
Amoxicillin-clavulanate
The duration and dose of empiric antibiotics will be determined by the treating clinician and local guidelines or practice.
Standard course macrolide
Standard course of macrolide therapy, discontinued between study day 3 and the end of study day 5. The dosing of and route of administration is not protocolised, the following guidance is provided: * Initial IV administration of a macrolide is strongly preferred * The preferred IV macrolide is azithromycin, but IV clarithromycin may be substituted. * The preferred enteral macrolide is azithromycin, but enteral clarithromycin or roxithromycin may be substituted.
Extended course macrolide
Extended course of macrolide therapy discontinued at the end of study day 14 or hospital discharge (whichever occurs first). The dosing of and route of administration is not protocolised, the following guidance is provided: * Initial IV administration of a macrolide is strongly preferred * The preferred IV macrolide is azithromycin, but IV clarithromycin may be substituted. * The preferred enteral macrolide is azithromycin, but enteral clarithromycin or roxithromycin may be substituted.
No systemic corticosteroid
Patients are not to receive any systemic corticosteroids, including hydrocortisone, to study day 28 or hospital discharge (whichever occurs first).
Fixed-duration Hydrocortisone
50mg of intravenous hydrocortisone will be administered every 6 hours for up to 7 days. Note: this intervention is now closed.
Shock-dependent hydrocortisone
50mg IV hydrocortisone every 6 hours while the patient is in septic shock
Fixed-duration higher dose Hydrocortisone
100mg of intravenous hydrocortisone will be administered every 6 hours for up to 7 days. Note: this intervention was only available to patients with suspected or proven COVID-19 and is now closed.
No antiviral agent for influenza
No antiviral agent intended to be active against influenza infection is to be administered
Five-days oseltamivir
Oseltamivir administered enterally twice daily for 5 days or until hospital discharge (whichever occurs first)
Ten-days oseltamivir
Oseltamivir administered enterally twice daily for 10 days or until hospital discharge (whichever occurs first)
No antiviral agent for COVID-19
No antiviral agent intended to be active against SARS-CoV-2 infection is to be administered
Lopinavir / Ritonavir
Lopinavir/ritonavir 400/100mg administered enterally, or 5ml 80/20mg per mL solution suspension via gastric tube, every 12 hours. Administered for a minimum of 5 days, including if discharged from ICU prior to end of study day 5. For patients discharged from ICU between study day 6 and study day 14, lopinavir/ritonavir is ceased at ICU discharge. Lopinavir/ritonavir is ceased at the end of study day 14 if the patient remains in ICU. Note: this intervention is now closed.
Hydroxychloroquine
Loading dose of 800mg hydroxychloroquine administered enterally every 6 hours until 2 doses have been administered. Subsequently, 400mg hydroxychloroquine will be administered enterally every 12 hours for 12 doses or ICU discharge (whichever occurs first). Note: this intervention is now closed.
Hydroxychloroquine + lopinavir/ritonavir
Lopinavir/ritonavir 400/100mg administered enterally, or 5ml 80/20mg per mL solution suspension via gastric tube, every 12 hours. Administered for a minimum of 5 days, including if discharged from ICU prior to end of study day 5. For patients discharged from ICU between study day 6 and study day 14, lopinavir/ritonavir is ceased at ICU discharge. Lopinavir/ritonavir is ceased at the end of study day 14 if the patient remains in ICU. Loading dose of 800mg hydroxychloroquine administered enterally every 6 hours until 2 doses have been administered. Subsequently, 400mg hydroxychloroquine will be administered enterally every 12 hours for 12 doses or ICU discharge (whichever occurs first). Note: this intervention is now closed.
Ivermectin
Ivermectin administered enterally at a dose of 0.2 mg/kg once daily with a maximum daily dose of 24mg/day. Note: this intervention is now closed.
No immune modulation for COVID-19
No immune modulating agent intended to be active against COVID-19 is to be administered. Note: this intervention is now closed.
Interferon beta-1a
IFN-β1a 10 μg will be administered as an intravenous bolus injection via a central or peripheral line. IFN-β1a will be administered once daily for 6 days or until ICU discharge, whichever occurs first. Note: this intervention is now closed.
Anakinra
A loading dose of 300mg anakinra will be administered as a bolus via central or peripheral line. This is followed by maintenance doses of 100mg of anakinra administered every 6 hours. In patients with renal impairment, anakinra will be administered on alternate days. Note: this intervention is now closed.
Tocilizumab
Tocilizumab will be administered as a single dose of 8mg/kg estimated or measured body weight, with a maximum total dose of 800mg. Tocilizumab will be administered as an IV infusion via central or peripheral line over a one-hour period. Note: this intervention is now closed.
Sarilumab
Sarilumab will be administered as a single dose of 400mg, via IV infusion through peripheral or central line over a one-hour period. Note: this intervention is now closed.
Local standard venous thromboprophylaxis
Standard venous thromboprophylaxis that complies with local guidelines or usual practice will be administered for 14 days following randomisation or until hospital discharge, whichever occurs first. Note: this intervention is now closed.
Therapeutic dose anticoagulation
Patients will be administered either low molecular weight heparin (LMWH) or unfractionated heparin (UFH) to achieve systemic anticoagulation. Either agent may be used and the same patient may be switched between UFH and LMWH at the discretion of the treating clinician. Note: this intervention is now closed.
Conventional low dose thromboprophylaxis
Low dose thromboprophylaxis will be administered for 14 days following randomisation or until hospital discharge, whichever occurs first. Dosing is outlined in the relevant protocol documents for this domain.
Intermediate dose thromboprophylaxis
Intermediate dose thromboprophylaxis will be administered for 14 days following randomisation or until hospital discharge, whichever occurs first. Dosing is outlined in the relevant protocol documents for this domain.
Continuation of therapeutic dose anticoagulation
Patients already receiving therapeutic dose anticoagulation at the time of randomisation to this intervention will be administered either unfractionated heparin by IV infusion or low-molecular weight heparin to achieve systemic anticoagulation according to local practice for acute VTE treatment for 14 days following randomisation or until hospital discharge, whichever occurs first. Note: this intervention is now closed.
No immunoglobulin
No immunoglobulin intended to be active against SARS-CoV-2 infection is to be administered.
Convalescent plasma
Patients will receive at least one and no more than two units of ABO compatible convalescent plasma within 48 hours of randomisation.
Delayed administration of convalescent plasma
Note: this intervention is now closed.
No vitamin C
No high dose intravenous vitamin C is to be administered Note: this intervention is now closed.
Vitamin C
Intravenous Vitamin C 50mg/kg administered every 6 hours for 16 doses Note: this intervention is now closed.
No antiplatelet
No antiplatelet agent or NSAID to be administered. Note: this intervention is now closed.
Aspirin
Aspirin administered at either 75mg or 100mg once per day for 14 days or until hospital discharge, whichever occurs first. Note: this intervention is now closed.
P2Y12 inhibitor
Site-selected P2Y12 inhibitor: * Clopidogrel: administered 75 mg once per day for 14 days or until hospital discharge, whichever occurs first. * Prasugrel: If patient is aged less than 75 years and measured or estimated weight if 60kg or more, and initial loading dose of prasugrel 60 mg will be administered, followed by maintenance dose of 10 mg per day. * Ticagrelor: administered enterally at 60mg twice daily for 14 days or until hospital discharge, whichever occurs first. Note: this intervention is now closed.
No simvastatin
No simvastatin intended to be active against COVID-19 is to be administered Note: this intervention is now closed.
Simvastatin
Simvastatin 80mg administered once daily via enteral route, while the patient remains in hospital up to 28 days after randomisation Note: this intervention is now closed.
Eritoran
Eritoran initiated with a 26.24 mg loading dose (6.56 mg/h IV for 4 hours), followed by a second 13.12 mg loading dose (6.56 mg/h IV for 2 hours) at 12 hours after initiation. Patients will then receive twenty-six 6.56 mg maintenance doses (3.28 mg/h IV for 2 hours) every 12 hours thereafter (total of 14 days). Dosing will be stopped if the patient is discharged from hospital Note: this intervention is now closed.
Apremilast
Apremilast administered 30mg twice daily for 14 days or until hospital discharge, whichever occurs first. Note: this intervention is now closed.
Clinician-preferred mechanical ventilation strategy
Clinician-preferred ventilation strategy, including mode of ventilation and all ventilatory parameters
Protocolised mechanical ventilation strategy
Invasive mechanical ventilation strategy delivered as outlined in relevant protocol documents for this domain.
No renin-angiotensin system inhibitor
No RAS inhibitor (i.e. no ACEi or ARB) is to be administered up to the end of study day 10. Note: this intervention is now closed.
Angiotensin converting enzyme inhibitor
Site-preferred ACEi agent administered as directed by the treating clinician for 10 days or until hospital discharge, whichever occurs first. Note: this intervention is now closed.
Angiotensin Receptor Blockers
Site-preferred ARB agent administered as directed by the treating clinician for 10 days or until hospital discharge, whichever occurs first. Note: this intervention is now closed.
ARB + DMX-200
Site-preferred ARB agent administered in combination with DMX-200 for 10 days or until hospital discharge, whichever occurs first. ARB administered as directed by the treating clinician. DMX-200 administered enterally at a dose of 120mg twice daily. Note: this intervention is now closed.
No cysteamine
No cysteamine to be administered until the end of study day 10 or hospital discharge, whichever occurs first. Note: this intervention is now closed.
Cysteamine
Cysteamine administered every 8 hours at a dose of 5 mg/kg estimated or measured body weight (maximum dose of 500mg), for ten days or until ICU discharge, whichever occurs first. Note: this intervention is now closed.
Fixed-duration dexamethasone
6 mg of IV or enteral dexamethasone will be administered daily for up to 10 days while in hospital.
Baloxavir Marboxil
Baloxavir marboxil administered on days 1 and 4 post-randomisation.
Five-days oseltamivir + baloxavir marboxil
Oseltamivir administered enterally twice daily for 5 days or until hospital discharge (whichever occurs first), in addition to baloxavir marboxil administered on days 1 and 4 post-randomisation.
Ten-days oseltamivir + baloxavir marboxil
Oseltamivir administered enterally twice daily for 10 days or until hospital discharge (whichever occurs first), in addition to baloxavir marboxil administered on days 1 and 4 post-randomisation.
No endothelial modulator
No endothelial modulator (imatinib or another tyrosine kinase inhibitor targeting the same pathway as imatinib) is to be administered.
Imatinib
Enteral imatinib will be administered as a single 800mg loading dose (study day 1) followed by 400mg daily until study day 14 or discharge.
No Immune Modulator for Influenza
No immune modulating agent intended to be active against influenza is to be administered.
Tocilizumab
Tocilizumab will be administered as a single dose of 8mg/kg estimated or measured body weight, with a maximum total dose of 800mg. In children weighing less than 30kg, tocilizumab dose will be 12mg/kg. Tocilizumab will be administered as an IV infusion via central or peripheral line over a one-hour period.
Baricitinib
Baricitinib will be administered at a dose that is determined by age and renal function, for up to 10 days or hospital discharge (whichever occurs first).
No antiviral agent for COVID-19
No antiviral agent intended to be active against SARS-CoV-2 infection is to be administered
Nirmatrelvir/ritonavir
Nirmatrelvir-ritonavir will be administered at a dose that is dependent on renal function, for five days.
Remdesivir
Remdesivir is administered at 200 mg on day one followed by 100 mg daily for a further four doses (i.e., for five doses in total) or until hospital discharge, whichever occurs first.
Nirmatrelvir/ritonavir + remdesivir
Nirmatrelvir-ritonavir will be administered at a dose that is dependent on renal function, for five days. Remdesivir is administered at 200 mg on day one followed by 100 mg daily for a further four doses (i.e., for five doses in total) or until hospital discharge, whichever occurs first.
Locations (408)
University of Florida
Jacksonville, Florida, United States
Augusta University
Augusta, Georgia, United States
University of Illinois Health
Chicago, Illinois, United States
Tulane Medical Center
New Orleans, Louisiana, United States
University of Michigan
Ann Arbor, Michigan, United States
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Wake Forest Baptist Health
Winston-Salem, North Carolina, United States
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States
Oregon Health and Science University
Portland, Oregon, United States
University of Pittsburgh Medical Centre
Pittsburgh, Pennsylvania, United States
Brown University - Rhode Island Hospital
Providence, Rhode Island, United States
Canberra Hospital
Canberra, Australian Capital Territory, Australia
Bankstown-Lidcombe Hospital
Bankstown, New South Wales, Australia
Blacktown Hospital
Blacktown, New South Wales, Australia
Campbelltown Hospital
Campbelltown, New South Wales, Australia
Sutherland Hospital
Caringbah, New South Wales, Australia
Concord Hospital
Concord, New South Wales, Australia
Dubbo Base Hospital
Dubbo, New South Wales, Australia
Northern Beaches Hospital
Frenchs Forest, New South Wales, Australia
Nepean Hospital
Kingswood, New South Wales, Australia
St. George Hospital
Kogarah, New South Wales, Australia
Liverpool Hospital
Liverpool, New South Wales, Australia
John Hunter Hospital
Newcastle, New South Wales, Australia
Orange Health Service
Orange, New South Wales, Australia
St Vincent's Hospital Sydney
Sydney, New South Wales, Australia
Prince of Wales Hospital
Sydney, New South Wales, Australia
Royal Prince Alfred Hospital
Sydney, New South Wales, Australia
Royal North Shore Hospital
Sydney, New South Wales, Australia
Wollongong Hospital
Sydney, New South Wales, Australia
Wagga Wagga Base Hospital
Wagga Wagga, New South Wales, Australia
Westmead Hospital
Westmead, New South Wales, Australia
Royal Darwin Hospital,
Darwin, Northern Territory, Australia
Sunshine Coast University Hospital
Birtinya, Queensland, Australia
The Prince Charles Hospital
Brisbane, Queensland, Australia
Mater Hospital Brisbane
Brisbane, Queensland, Australia
Princess Alexandra Hospital
Brisbane, Queensland, Australia
Caboolture Hospital
Caboolture, Queensland, Australia
Queen Elizabeth II Jubilee Hospital
Coopers Plains, Queensland, Australia
Logan Hospital
Logan City, Queensland, Australia
Redcliffe Hospital
Redcliffe, Queensland, Australia
Rockhampton Hospital
Rockhampton, Queensland, Australia
Gold Coast University Hospital
Southport, Queensland, Australia
Toowoomba Hospital
Toowoomba, Queensland, Australia
Townsville Hospital
Townsville, Queensland, Australia
Royal Adelaide Hospital
Adelaide, South Australia, Australia
The Queen Elizabeth Hospital
Adelaide, South Australia, Australia
Lyell McEwin Hospital
Adelaide, South Australia, Australia
Flinders Medical Centre
Bedford Park, South Australia, Australia
Launceston Hospital
Launceston, Tasmania, Australia
Ballarat Base Hospital
Ballarat, Victoria, Australia
Bendigo Hospital
Bendigo, Victoria, Australia
Casey Hospital
Berwick, Victoria, Australia
Box Hill Hospital
Box Hill, Victoria, Australia
Monash Medical Centre
Clayton, Victoria, Australia
Dandenong Hospital
Dandenong, Victoria, Australia
Angliss Hospital
Ferntree Gully, Victoria, Australia
Footscray Hospital
Footscray, Victoria, Australia
University Hosptial Geelong
Geelong, Victoria, Australia
The Alfred Hospital
Melbourne, Victoria, Australia
Royal Melbourne Hospital
Melbourne, Victoria, Australia
St Vincent's Hospital Melbourne
Melbourne, Victoria, Australia
Maroondah Hospital
Ringwood East, Victoria, Australia
Sunshine Hospital
Sunshine, Victoria, Australia
Werribee Mercy Hospital
Werribee, Victoria, Australia
St John of God Hospital Midland
Midland, Western Australia, Australia
St John of God Hospital Murdoch
Murdoch, Western Australia, Australia
Royal Perth Hospital
Perth, Western Australia, Australia
Sir Charles Gairdner Hospital
Perth, Western Australia, Australia
Fiona Stanley Hospital
Perth, Western Australia, Australia
St John of God Subiaco
Subiaco, Western Australia, Australia
CHU de Charleroi - Hôpital Civil Marie Curie
Charleroi, Belgium
Universitair Ziekenhuis Gent
Ghent, Belgium
CHU Namur site Godinne
Namur, Belgium
Foothills Medical Centre
Calgary, Alberta, Canada
Peter Lougheed Centre
Calgary, Alberta, Canada
Rockyview General Hospital
Calgary, Alberta, Canada
South Health Campus
Calgary, Alberta, Canada
Royal Alexandra Hospital, Alberta
Edmonton, Alberta, Canada
University of Alberta Hospital
Edmonton, Alberta, Canada
Surrey Memorial Hospital
Surrey, British Columbia, Canada
St Boniface General Hospital
Winnipeg, Manitoba, Canada
Health Sciences Centre Winnipeg
Winnipeg, Manitoba, Canada
Grace Hospital
Winnipeg, Manitoba, Canada
Dr. Everett Chalmers Regional Hospital
Fredericton, New Brunswick, Canada
The Moncton Hospital
Fredericton, New Brunswick, Canada
The Saint John General Hospital
Fredericton, New Brunswick, Canada
William Osler Health System
Brampton, Ontario, Canada
Brantford General Hospital
Brantford, Ontario, Canada
Hamilton general Hospital
Hamilton, Ontario, Canada
Juravinski Hospital
Hamilton, Ontario, Canada
St. Joseph's Healthcare Hamilton
Hamilton, Ontario, Canada
Kingston Health Sciences Centre
Kingston, Ontario, Canada
Grand River Hospital
Kitchener, Ontario, Canada
St Mary's General Hospital
Kitchener, Ontario, Canada
The Ottawa Hospital
Ottawa, Ontario, Canada
Niagara Health
Saint Catharines, Ontario, Canada
Thunder Bay General Hospital
Thunder Bay, Ontario, Canada
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
St. Michael's Hospital Unity Health Toronto
Toronto, Ontario, Canada
Mount Sinai Hospital
Toronto, Ontario, Canada
Toronto General Hospital
Toronto, Ontario, Canada
Toronto Western Hospital
Toronto, Ontario, Canada
St Joseph's Health Centre
Toronto, Ontario, Canada
CIUSS Chaudieres-Appalaches (Levis)
Lévis, Quebec, Canada
Hospital Maisonneuve-Rosemont
Montreal, Quebec, Canada
Hôpital Fleury
Montreal, Quebec, Canada
Centre Hospitalier de l'Universite de Montreal
Montreal, Quebec, Canada
McGill University Health Centre
Montreal, Quebec, Canada
Hopital du Sacre-Coeur de Montreal
Montreal, Quebec, Canada
CHU de Québec - Université Laval
Québec, Quebec, Canada
IUCPQ-UL
Québec, Quebec, Canada
Centre Hospitalier de l'Université de Sherbrooke
Sherbrooke, Quebec, Canada
Regina General Hospital
Saskatoon, Saskatchewan, Canada
Universidad de La Sabana
Chía, Cundinamarca, Colombia
General County Hospital Požega
Požega, Croatia
University Hospital Centre Zagreb
Zagreb, Croatia
University Hospital for Infectious Diseases
Zagreb, Croatia
Fakultní nemocnice Královské Vinohrady
Prague, Czechia
Teplice Hospital
Teplice, Czechia
Tartu University Hospital
Tartu, Estonia
Helsinki University Hospital
Helsinki, Finland
Tampere University Hospital
Tampere, Finland
CH Argenteuil
Argenteuil, France
Centre Hospitalier Henri Mondor d'Aurillac
Aurillac, France
Beauvais General Hospital
Beauvais, France
Hopital Nord Franche-Comte
Belfort, France
Centre hospitalier Bethune Beuvry
Béthune, France
Ambroise Pare Hospital
Boulogne-Billancourt, France
CH de Dax
Dax, France
Centre Hospitalier de Dieppe
Dieppe, France
CHU Dijon Bourgogne
Dijon, France
Hopital Simone Veil Eaubonne
Eaubonne, France
Sud Essonne Hospital Etampes
Étampes, France
Hospital Raymond Poincare
Garches, France
CHD Vendee
La Roche-sur-Yon, France
Centre Hospitalier Le Mans
Le Mans, France
CHU Dupuytren
Limoges, France
Centre Hospitalier de Melun
Melun, France
Centre Hospitalier Layne - Mont-de-Marsan
Mont-de-Marsan, France
Centre Hospitalier des Pays de Morlaix
Morlaix, France
CHR d'Orleans
Orléans, France
Lariboisiere Hospital
Paris, France
Hopital Tenon
Paris, France
Nouvel Hopital Civil Strasbourg
Strasbourg, France
Hopital de Hautepierre Strasbourg
Strasbourg, France
CHRU Tours Hopital Bretonneau
Tours, France
Charité - Universitätsmedizin Berlin - Infektiologie und Pneumologie
Berlin, Germany
Vivantes Klinikum Neukölln
Berlin, Germany
Charite Universitätsmedizin Berlin
Berlin, Germany
Vivantes Humboldt-Klinikum
Berlin, Germany
University Hospital of Cologne
Cologne, Germany
Carl-Thiem-Klinikum Cottbus
Cottbus, Germany
Klinikum Dortmund
Dortmund, Germany
Elisabeth Hospital Essen
Essen, Germany
Universitätsklinikum Frankfurt
Frankfurt, Germany
University Medical Center Hamburg-Eppendorf (UKE)
Hamburg, Germany
Universitätsklinikum Jena
Jena, Germany
University Hospital Leipzig
Leipzig, Germany
Universitätsklinikum Leipzig
Leipzig, Germany
Klinikum rechts der Isar der TU München
München, Germany
Universitätsklinikum Münster
Münster, Germany
Universitäts Klinikum Tübingen
Tübingen, Germany
Universitätsklinikum Würzburg
Würzburg, Germany
Jósa András County Hospital
Nyíregyháza, Hungary
Almási Balogh Pál Kórház
Ózd, Hungary
Apollo Main Hospital
Chennai, Tamil Nadu, India
Apollo First Med Hospital
Chennai, Tamil Nadu, India
Apollo Vanagaram Hospital
Chennai, Tamil Nadu, India
Apollo Speciality Hospital - OMR
Chennai, Tamil Nadu, India
Cork University Hospital
Cork, Ireland
Beaumont Hospital
Dublin, Ireland
St. Vincent's University Hospital
Dublin, Ireland
University Hospital Galway
Galway, Ireland
University Hospital Waterford
Waterford, Ireland
Rambam Medical Center
Haifa, Israel
Beilinson Hospital, Rabin Medical Center
Petah Tikva, Israel
The Baruch Padeh Medical Center
Poria – Neve Oved, Israel
AO Spedali Civili di Brescia
Brescia, Italy
Humanitas Research Hospital
Milan, Italy
Ca' Granda Ospedale Maggiore Policlinico
Milan, Italy
IRCCS Ospedale San Raffaele
Milan, Italy
Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone
Palermo, Italy
Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione
Palermo, Italy
Arcispedale S. Maria Nuova
Reggio Emilia, Italy
Ospedale Infermi di Rimini
Rimini, Italy
St Marianna University School of Medicine
Kawasaki, Kanagawa, Japan
Yokohama City University Hospital
Yokohama, Kanagawa, Japan
St. Marianna University Yokohama City Seibu Hospital
Yokohama, Kanagawa, Japan
Saiseikai Kumamoto Hospital
Minami, Kumamoto, Japan
Osaka City General Hospital
Osaka, Japan
Nerima Hikarigaoka Hospital
Tokyo, Japan
Tokyo Metropolitan Bokutoh Hospital
Tokyo, Japan
Itabashi Chuo Medical Center
Tokyo, Japan
Tokyo bay Urayasu-Ichikawa Medical Center
Tokyo, Japan
Wakayama Medical University
Wakayama, Japan
Chitwan Medical College
Bharatpur, Nepal
Grande International Hospital
Kathmandu, Nepal
Hospital for Advanced Medicine and Surgery (HAMS)
Kathmandu, Nepal
Nepal Mediciti
Kathmandu, Nepal
Jeroen Bosch Ziekenhuis
's-Hertogenbosch, Netherlands
ZGT Almelo
Almelo, Netherlands
Meander Medisch Centrum
Amersfoort, Netherlands
OLVG
Amsterdam, Netherlands
Rijnstate Hospital
Arnhem, Netherlands
Deventer Hospital
Deventer, Netherlands
Ziekenhuis Gelderse Vallei
Ede, Netherlands
Maxima Medisch Centrum Eindhoven
Eindhoven, Netherlands
Martini Hospital Groningen
Groningen, Netherlands
University Medical Center Groningen
Groningen, Netherlands
Medisch Centrum Leeuwarden
Leeuwarden, Netherlands
Leiden University Medical Center
Leiden, Netherlands
Canisius Wilhelmina Ziekenhuis
Nijmegen, Netherlands
Radboud University Medical Center
Nijmegen, Netherlands
Laurentius Hospital
Roermond, Netherlands
Maasstad Ziekenhuis
Rotterdam, Netherlands
Hagaziekenhuis
The Hague, Netherlands
Bernhoven Hospital
Uden, Netherlands
University Medical Center Utrecht
Utrecht, Netherlands
North Shore Hospital
Auckland, New Zealand
CVICU, Auckland City Hospital
Auckland, New Zealand
DCCM, Auckland City Hospital
Auckland, New Zealand
Middlemore Hospital
Auckland, New Zealand
Christchurch Hospital
Christchurch, New Zealand
Waikato Hospital
Hamilton, New Zealand
Taranaki Base Hospital
New Plymouth, New Zealand
Rotorua Hospital
Rotorua, New Zealand
Tauranga Hospital
Tauranga, New Zealand
Wellington Regional Hospital
Wellington, New Zealand
Whangarei Hospital
Whangarei, New Zealand
Ziauddin University Hospital Clifton Campus
Karachi, Sindh, Pakistan
Abbasi Shaheed Hospital
Karachi, Sindh, Pakistan
National Institute of Cardiovascular Diseases, Karachi
Karachi, Sindh, Pakistan
South City Hospital, Karachi
Karachi, Sindh, Pakistan
Ziauddin University North Nazimabad Campus
Karachi, Sindh, Pakistan
Centro Hospitalar do Medio Tejo
Abrantes, Portugal
Hospital Ocidental
Lisbon, Portugal
Hospital Lusíadas Lisbon
Lisbon, Portugal
Clinical Hospital of Infectious and Tropical Diseases "Dr. Victor Babes"
Bucharest, Romania
King Abdulaziz Medical City
Riyadh, Saudi Arabia
University Clinical Centre of Serbia
Belgrade, Serbia
University Hospital Center Dr Dragiša Mišović
Belgrade, Serbia
Clinical Centre of Niš
Niš, Serbia
University Clinic of Respiratory and Allergic Diseases Golnik
Golnik, Slovenia
University Medical Centre Maribor
Maribor, Slovenia
Hospital del Mar
Barcelona, Spain
Hospital Universitario de Jerez
Cadiz, Spain
Reina Sofia University Hospital
Córdoba, Spain
Ramon y Cajal University Hospital
Madrid, Spain
Hospital Regional de Málaga
Málaga, Spain
Hospital Universitario de Ourense
Ourense, Spain
Hospital Marqués de Valdecilla
Santander, Spain
Hospital Verge de la Cinta
Tortosa, Spain
Doctor Peset University Hospital
Valencia, Spain
Hospital La Fe
Valencia, Spain
University Hospital Zürich
Zurich, Switzerland
Basildon Hospital
Basildon, England, United Kingdom
Basingstoke and North Hampshire Hospital
Basingstoke, England, United Kingdom
Royal United Hospital, Bath
Bath, England, United Kingdom
Queen Elizabeth Hospital Birmingham
Birmingham, England, United Kingdom
Birmingham City Hospital
Birmingham, England, United Kingdom
Royal Blackburn Teaching Hospital
Blackburn, England, United Kingdom
Pilgrim Hospital ULHT
Boston, England, United Kingdom
Royal Bournemouth Hospital
Bournemouth, England, United Kingdom
Royal Sussex County Hospital
Brighton, England, United Kingdom
Southmead Hospital
Bristol, England, United Kingdom
Bristol Royal Infirmary
Bristol, England, United Kingdom
Queen's Hospital, Burton
Burton-on-Trent, England, United Kingdom
Royal Papworth Hospital
Cambridge, England, United Kingdom
Addenbrookes Hospital
Cambridge, England, United Kingdom
North Cumberland Infirmary
Carlisle, England, United Kingdom
St Peter's Hospital
Chertsey, England, United Kingdom
Countess of Chester Hospital
Chester, England, United Kingdom
Chesterfield Royal Hospital
Chesterfield, England, United Kingdom
Colchester Hospital
Colchester, England, United Kingdom
University Hospital Coventry
Coventry, England, United Kingdom
Darlington Memorial Hospital
Darlington, England, United Kingdom
Darent Valley Hospital
Dartford, England, United Kingdom
Russells Hall Hospital
Dudley, England, United Kingdom
Royal Devon and Exeter Hospital
Exeter, England, United Kingdom
Frimley Park Hospital
Frimley, England, United Kingdom
Queen Elizabeth Hospital Gateshead
Gateshead, England, United Kingdom
Medway Maritime Hospital
Gillingham, England, United Kingdom
James Paget University Hospital
Great Yarmouth, England, United Kingdom
Royal Surrey County Hospital
Guildford, England, United Kingdom
Northwick Park Hospital
Harrow, England, United Kingdom
Hereford County Hospital
Hereford, England, United Kingdom
Barnet Hospital
High Barnet, England, United Kingdom
Huddersfield Royal Infirmary
Huddersfield, England, United Kingdom
King George Hospital
Ilford, England, United Kingdom
Ipswich Hospital
Ipswich, England, United Kingdom
Kettering Hospital
Kettering, England, United Kingdom
Leeds General Infirmary
Leeds, England, United Kingdom
Leicester Royal Infirmary
Leicester, England, United Kingdom
Glenfield Hospital
Leicester, England, United Kingdom
Lincoln County Hospital
Lincoln, England, United Kingdom
Liverpool Heart and Chest Hospital
Liverpool, England, United Kingdom
Alder Hey Hospital
Liverpool, England, United Kingdom
Royal Liverpool University Hospital
Liverpool, England, United Kingdom
University Hospital Aintree
Liverpool, England, United Kingdom
Croydon University Hospital
London, England, United Kingdom
Royal London Hospital
London, England, United Kingdom
Whipps Cross Hospital
London, England, United Kingdom
Newham University Hospital
London, England, United Kingdom
St Bartholomew's Hospital
London, England, United Kingdom
North Middlesex University Hospital
London, England, United Kingdom
Royal Free Hospital
London, England, United Kingdom
St Thomas Hospital
London, England, United Kingdom
Guy's Hospital
London, England, United Kingdom
Queen Elizabeth Hospital, Woolwich
London, England, United Kingdom
King's College Hospital
London, England, United Kingdom
St George's University Hospital
London, England, United Kingdom
Royal Marsden Hospital
London, England, United Kingdom
Royal Brompton Hospital
London, England, United Kingdom
Hammersmith Hospital
London, England, United Kingdom
St Mary's Hospital
London, England, United Kingdom
Charing Cross Hospital
London, England, United Kingdom
Luton and Dunstable University Hospital
Luton, England, United Kingdom
Maidstone Hospital
Maidstone, England, United Kingdom
Manchester Royal Infirmary
Manchester, England, United Kingdom
The Christie Hospital
Manchester, England, United Kingdom
Wythenshawe Hospital
Manchester, England, United Kingdom
North Manchester General Hospital
Manchester, England, United Kingdom
Arrowe Park Hospital
Metropolitan Borough of Wirral, England, United Kingdom
The James Cook University Hospital
Middlesbrough, England, United Kingdom
Milton Keynes University Hospital
Milton Keynes, England, United Kingdom
Royal Victoria Infirmary, Newcastle
Newcastle, England, United Kingdom
Newcastle Freeman Hospital
Newcastle, England, United Kingdom
Northampton General Hospital
Northampton, England, United Kingdom
Norfolk and Norwich University Hospital
Norwich, England, United Kingdom
City Hospital Nottingham
Nottingham, England, United Kingdom
Queen's Medical Centre - Nottingham University Hospitals NHS Trust
Nottingham, England, United Kingdom
George Eliot Hospital
Nuneaton, England, United Kingdom
Royal Oldham Hospital
Oldham, England, United Kingdom
Princess Royal University Hospital
Orpington, England, United Kingdom
John Radcliffe Hospital
Oxford, England, United Kingdom
Derriford Hospital
Plymouth, England, United Kingdom
Poole Hospital NHS Foundation Trust
Poole, England, United Kingdom
Queen Alexandra Hospital
Portsmouth, England, United Kingdom
Whiston Hospital
Prescot, England, United Kingdom
Royal Preston Hospital
Preston, England, United Kingdom
Royal Berkshire Hospital
Reading, England, United Kingdom
Alexandra Hospital, Redditch
Redditch, England, United Kingdom
Queen's Hospital Romford
Romford, England, United Kingdom
Rotherham Hospital
Rotherham, England, United Kingdom
Tunbridge Wells Hospital - Maidstone and Tunbridge Wells NHS Trust
Royal Tunbridge Wells, England, United Kingdom
Salford Royal Hospital
Salford, England, United Kingdom
Salisbury District Hospital
Salisbury, England, United Kingdom
Royal Hallamshire Hospital
Sheffield, England, United Kingdom
Northern General Hospital
Sheffield, England, United Kingdom
Wexham Park Hospital
Slough, England, United Kingdom
South Tyneside District Hospital
South Shields, England, United Kingdom
Southampton General Hospital
Southampton, England, United Kingdom
Stepping Hill Hospital
Stockport, England, United Kingdom
University Hospital of North Tees
Stockton-on-Tees, England, United Kingdom
Royal Stoke University Hospital
Stoke-on-Trent, England, United Kingdom
Sunderland Royal Hospital
Sunderland, England, United Kingdom
King's Mill Hospital
Sutton in Ashfield, England, United Kingdom
Great Western Hospital
Swindon, England, United Kingdom
Western General Hospital
Swindon, England, United Kingdom
Musgrove Park Hospital
Taunton, England, United Kingdom
Torbay Hospital
Torquay, England, United Kingdom
Royal Cornwall Hospital
Truro, England, United Kingdom
Harefield Hospital
Uxbridge, England, United Kingdom
Watford General Hospital
Watford, England, United Kingdom
Southend Hospital
Westcliff-on-Sea, England, United Kingdom
West Cumberland Hospital
Whitehaven, England, United Kingdom
Royal Albert Edward Infirmary
Wigan, England, United Kingdom
Royal Hampshire County Hospital
Winchester, England, United Kingdom
New Cross Hospital Wolverhampton
Wolverhampton, England, United Kingdom
Worcestershire Royal Hospital
Worcester, England, United Kingdom
York Teaching Hospital
York, England, United Kingdom
Antrim Area Hospital
Antrim, Northern Ireland, United Kingdom
Royal Victoria Hospital Belfast
Belfast, Northern Ireland, United Kingdom
Mater Hospital
Belfast, Northern Ireland, United Kingdom
Belfast City Hospital
Belfast, Northern Ireland, United Kingdom
Altnagelvin Hospital
Londonderry, Northern Ireland, United Kingdom
Aberdeen Royal Infirmary
Aberdeen, Scotland, United Kingdom
Ninewells Hospital
Dundee, Scotland, United Kingdom
Royal Infirmary of Edinburgh
Edinburgh, Scotland, United Kingdom
Glasgow Royal Infirmary
Glasgow, Scotland, United Kingdom
Queen Elizabeth University Hospital, Glasgow
Glasgow, Scotland, United Kingdom
Royal Alexandra Hospital
Paisley, Scotland, United Kingdom
Neville Hall Hospital
Abergavenny, Wales, United Kingdom
Glan Clwyd Hospital
Bodelwyddan, Wales, United Kingdom
Princess of Wales Hospital
Bridgend, Wales, United Kingdom
Cardiff and Vale University Hospital Wales
Cardiff, Wales, United Kingdom
Glangwilli Hospital
Carmarthen, Wales, United Kingdom
Grange University Hospital
Cwmbran, Wales, United Kingdom
Royal Gwent Hospital
Newport, Wales, United Kingdom
Royal Glamorgan Hospital
Pont-y-clun, Wales, United Kingdom
Morriston Hospital
Swansea, Wales, United Kingdom
Wrexham Maelor Hospital
Wrexham, Wales, United Kingdom
Ulster Hospital
Belfast, United Kingdom
Bristol Royal Childrens Hospital
Bristol, United Kingdom
Fairfield General Hospital
Bury, United Kingdom
Leighton Hospital
Crewe, United Kingdom
Dorset County Hospital
Dorchester, United Kingdom
Gloucester Royal Hospital
Gloucester, United Kingdom
The Princess Royal Hospital Haywards Heath
Haywards Heath, United Kingdom
St. James University Hospital
Leeds, United Kingdom
Homerton Hospital
London, United Kingdom
University College London Hospital
London, United Kingdom
Chelsea and Westminster Hospital
London, United Kingdom
Queen Elizabeth and Queen Mother Hospital
Margate, United Kingdom
Newcastle Royal Victoria Infirmary (Paediatrics)
Newcastle upon Tyne, United Kingdom
North Tyneside General Hospital
North Shields, United Kingdom
Warwick Hospital
Warwick, United Kingdom
Sandwell General Hospital
West Bromwich, United Kingdom