Transcript CARRESS - Duke University

CARRESS
Cardiorenal Rescue Study in
Acute Decompensated Heart
Failure
Duke Heart Failure Research
Pager: 970-0736
Purpose

Randomized, controlled, multi-center clinical
trial to test the hypothesis that ultrafiltration
compared to a stepped pharmacological care
approach will result in improved renal
function and relief of congestion in patients
hospitalized with acute decompensated heart
failure (ADHF) and cardiorenal syndrome.
Inclusion Criteria

Patients admitted with
ADHF who develop
cardiorenal syndrome

Cardiorenal
syndrome:
 serum creatinine
concentration >0.3
mg/dL in setting of
persistent congestion
Interventions
Randomized to
1 of 2
treatments
Slow continuous
venous
ultrafiltration
Stepped pharmacologic
care
Interventions

ULTRAFILTRATION (UF)
GROUP
–
–
–
–
Loop diuretics d/c’d during UF
Receive Heparin; goal PTT
2-2.5x normal
UF fluid removal 200cc/hr;
continue until signs/symptoms
of congestion optimized
Patients randomized to UF
group must be transferred to
7300 unit to receive treatment

STEPPED
PHARMACOLOGIC GROUP
–
–
–
IV diuretics used to address
signs/symptoms of
congestion
Completed when volume
status optimized
Algorithm by Heart Failure
Network provided;
addresses intensification of
diuretics and use of
vasodilators and inotropes
Nursing Roles

Ensure fluid restriction and 2gm Na diet as ordered

Weigh patients before treatment and daily qAM

Record I&O

Administer study drugs according to CPOE orders
Nursing Roles

For patients randomized to UF arm:
–
–
–
–
–
–
ELC* + 18 gauge IV
Heparin protocol; start when PTT 50-75
Hold diuretics
UF removal rate 200cc/hr
VS q15 min x1 hr, q 30-60 min x4 hr, q 4 hrs
Secure and flush post treatment policy
*ELC = extended-length catheter
Outcomes
Why is this study being done?

To look at the safety and efficacy of UF for treatment
of persistent congestion and cardiorenal syndrome
as measured by:
–
–
–
–
–
Change in serum creatinine AND weight
Treatment failure
Change in electrolytes
% achieving clinical decongestion
Total net fluid loss