Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial.

Published

Journal Article

BACKGROUND: Medical treatment for acute heart failure (AHF) has not changed substantially over the last four decades. Emergency department (ED)-based evidence for treatment is limited. Outcomes remain poor, with a 25% mortality or re-admission rate within 30days post discharge. Targeting pulmonary congestion, which can be objectively assessed using lung ultrasound (LUS), may be associated with improved outcomes. METHODS: BLUSHED-AHF is a multicenter, randomized, pilot trial designed to test whether a strategy of care that utilizes a LUS-driven treatment protocol outperforms usual care for reducing pulmonary congestion in the ED. We will randomize 130 ED patients with AHF across five sites to, a) a structured treatment strategy guided by LUS vs. b) a structured treatment strategy guided by usual care. LUS-guided care will continue until there are ≤15 B-lines on LUS or 6h post enrollment. The primary outcome is the proportion of patients with B-lines ≤ 15 at the conclusion of 6 h of management. Patients will continue to undergo serial LUS exams during hospitalization, to better understand the time course of pulmonary congestion. Follow up will occur through 90days, exploring days-alive-and-out-of-hospital between the two arms. The study is registered on ClinicalTrials.gov (NCT03136198). CONCLUSION: If successful, this pilot study will inform future, larger trial design on LUS driven therapy aimed at guiding treatment and improving outcomes in patients with AHF.

Full Text

Duke Authors

Cited Authors

  • Russell, FM; Ehrman, RR; Ferre, R; Gargani, L; Noble, V; Rupp, J; Collins, SP; Hunter, B; Lane, KA; Levy, P; Li, X; O'Connor, C; Pang, PS

Published Date

  • May 2019

Published In

Volume / Issue

  • 48 / 3

Start / End Page

  • 186 - 192

PubMed ID

  • 30448355

Pubmed Central ID

  • 30448355

Electronic International Standard Serial Number (EISSN)

  • 1527-3288

Digital Object Identifier (DOI)

  • 10.1016/j.hrtlng.2018.10.027

Language

  • eng

Conference Location

  • United States