CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research...
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Transcript of CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research...
![Page 1: CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research Pager: 970-0736.](https://reader036.fdocuments.us/reader036/viewer/2022082505/56649f1e5503460f94c350e7/html5/thumbnails/1.jpg)
CARRESSCardiorenal Rescue Study in Acute Decompensated Heart Failure
Duke Heart Failure ResearchPager: 970-0736
![Page 2: CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research Pager: 970-0736.](https://reader036.fdocuments.us/reader036/viewer/2022082505/56649f1e5503460f94c350e7/html5/thumbnails/2.jpg)
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.
![Page 3: CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research Pager: 970-0736.](https://reader036.fdocuments.us/reader036/viewer/2022082505/56649f1e5503460f94c350e7/html5/thumbnails/3.jpg)
Inclusion Criteria
Patients admitted with ADHF who develop cardiorenal syndrome
Cardiorenal syndrome:
serum creatinine concentration >0.3 mg/dL in setting of persistent congestion
![Page 4: CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research Pager: 970-0736.](https://reader036.fdocuments.us/reader036/viewer/2022082505/56649f1e5503460f94c350e7/html5/thumbnails/4.jpg)
Interventions
Randomized to 1 of 2
treatments
Slow continuous venous
ultrafiltration
Stepped pharmacologiccare
![Page 5: CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research Pager: 970-0736.](https://reader036.fdocuments.us/reader036/viewer/2022082505/56649f1e5503460f94c350e7/html5/thumbnails/5.jpg)
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
![Page 6: CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research Pager: 970-0736.](https://reader036.fdocuments.us/reader036/viewer/2022082505/56649f1e5503460f94c350e7/html5/thumbnails/6.jpg)
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
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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
![Page 8: CARRESS Cardiorenal Rescue Study in Acute Decompensated Heart Failure Duke Heart Failure Research Pager: 970-0736.](https://reader036.fdocuments.us/reader036/viewer/2022082505/56649f1e5503460f94c350e7/html5/thumbnails/8.jpg)
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