Feasibility of the SCD in Cardiorenal Syndrome Patients Awaiting LVAD

Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorSeaStar Medical

About this trial

Cardiovascular disease is the leading cause of mortality in the US, accounting for 45% of all deaths. Chronic Heart Failure (CHF) is now understood to be a multi-system disease process involving not only the cardiovascular system but also the renal, neuroendocrine, and immune systems. No effective therapy is currently available to treat the most severe subset of CHF patients that have progressed to acute decompensated HF. An innovative approach to reduce the cardio-depressant effects associated with the chronic inflammatory state of CHF may provide a breakthrough for this disorder. This proposal will evaluate the safety and probable benefit to improve cardiac or renal function with an immunomodulatory device to bridge patients to Left Ventricular Assist Device (LVAD) implantation who were previously deemed ineligible for this life sustaining procedure. The Selective Cytopheretic Device (SCD) is an immuno-regulating, extracorporeal membrane device targeted to modulate the cardiodepressant effects assocaited with CHF. SCD is a platform technology focused on immunomodulation of acute and chronic inflammation associated with acute and chronic organ dysfunction. SCD membranes selectively sequester activated systemic leukocytes as they flow through the cartridge via an extracorporeal circuit. Pre-clinical results show that SCD treatment results in a 25% improvement in ejection fraction in a canine CHF model.

This study will enroll 20 patients across up to 5 clinical sites to evaluate the safety and initial efficacy data of SCD treatment in this indication. Patients will receive 4-hour daily SCD treatment for up to 6 days, followed by 6 months of follow up.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Age of 18 years and older.

Evidence of systemic inflammation: blood CRP ≥ 4.5 mg/L or IL-6 ≥ 5.0 pg/ml or neutrophil to lymphocyte ratio ≥3.0.

Primary hospitalization for acute decompensated chronic systolic heart failure.

Baseline eGFR** ≥ 40 ml/min/1.73 m2 (baseline defined as the highest known eGFR within 90 days of study enrollment)

Disqualifiers

Any clear contraindication to LVAD therapy that is unlikely to resolve with improvement in renal function and volume status

Prior sensitivity to dialysis device components

Active bacteremia

Temperature ≥ 101.5 F or WBC ≥ 10,000 K/uL or any patient with suspected systemic infection.

Trial design

Design model

Single group

Treatments tested in this trial

  • Selective Cytopheretic Device

    Device

    Treatment will be delivered for 4 hours a day for up to 6 consecutive days.

Treatment groups

20 Participants
are divided into 1 treatment group
Group A: Selective Cytopheretic DeviceExperimental treatment 1 intervention

Trial outcomes

Primary outcomes

1

Need for continuous IV vasopressor support

Need for continuous IV vasopressor support with \>5 total norepinephrine equivalents and/or \>3 vasopressor agents \>4 hours following termination of daily SCD therapy session to maintain a MAP \>60 mmHg, with norepinephrine equivalents defined as: 1. 1 x epinephrine (ug/kg/min) 2. 001 x dopamine (ug/kg/min) 3. 0.06 x phenylephrine (ug/kg/min) 4. 2.5 x vasopressin (U/min) (Note that use of inotropes (i.e., dobutamine and milrinone) or dopamine at ≤3 mcg/kg/min are not components of this measure.)

Time frame
measured daily, at or after 4 hours after termination of daily SCD therapy
2

Acute myocardial infarction

Acute myocardial infarction as evidenced by elevated cardiac enzymes, with electrocardiographic or imaging findings consistent with myocardial damage and confirmed by Cardiology.

Time frame
up to 6 months following SCD treatment initiation
3

Mortality

Death

Time frame
up to 6 months following SCD treatment initiation
4

Percentage of subjects with reversal of WRF and increase eGFR and PCW

Among patients with WRF, the percentage of subjects with reversal of WRF (≥ 0.5 mg/dL reduction of serum creatinine from level at study entry), and achieving an eGFR \> 30 ml/min/1.73 m2 and PCWP at or below level at study entry at termination of SCD therapy.

Time frame
up to 6 days after initiation of SCD therapy

Secondary outcomes

1

Percentage of subject receiving a left ventricular assist device

Time frame
up to 30 days after the last SCD
2

Change in 24 hour urine volume

Time frame
change from onset of intervention to 3 and 6 days after initiation of SCD treatments and from onset of intervention to end of SCD support prior to LVAD implantation
3

Change in urine sodium

Time frame
change from onset of intervention to 3 and 6 days after initiation of SCD treatments and from onset of intervention to end of SCD support prior to LVAD implantation
4

Change in urine creatinine

Time frame
change from onset of intervention to 3 and 6 days after initiation of SCD treatments and from onset of intervention to end of SCD support prior to LVAD implantation

Other outcomes

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

SeaStar Medical

Lead sponsor

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

University of Michigan

Collaborator

Innovative BioTherapies (IBT)

Collaborator