CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research Pager:

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 – Hold diuretics – UF removal rate 200cc/hr – VS q15 min x1 hr, q 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