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Randomized Controlled Trial
. 2021 Sep;9(9):638-648.
doi: 10.1016/j.jchf.2021.05.008. Epub 2021 Jul 7.

Lung Ultrasound-Guided Emergency Department Management of Acute Heart Failure (BLUSHED-AHF): A Randomized Controlled Pilot Trial

Peter S Pang  1 , Frances M Russell  2 , Robert Ehrman  3 , Rob Ferre  2 , Luna Gargani  4 , Phillip D Levy  3 , Vicki Noble  5 , Kathleen A Lane  6 , Xiaochun Li  6 , Sean P Collins  7
Affiliations
Randomized Controlled Trial

Lung Ultrasound-Guided Emergency Department Management of Acute Heart Failure (BLUSHED-AHF): A Randomized Controlled Pilot Trial

Peter S Pang et al. JACC Heart Fail. 2021 Sep.

Erratum in

  • Correction.
    Pang PS, Russell FM, Ehrman R, Ferre R, Gargani L, Levy PD, Noble V, Lane KA, Li X, Collins SP. Pang PS, et al. JACC Heart Fail. 2024 Aug;12(8):1507. doi: 10.1016/j.jchf.2024.06.005. JACC Heart Fail. 2024. PMID: 39111957 Free PMC article. No abstract available.

Abstract

Objectives: The goal of this study was to determine whether a 6-hour lung ultrasound (LUS)-guided strategy-of-care improves pulmonary congestion over usual management in the emergency department (ED) setting. A secondary goal was to explore whether early targeted intervention leads to improved outcomes.

Background: Targeting pulmonary congestion in acute heart failure remains a key goal of care. LUS B-lines are a semi-quantitative assessment of pulmonary congestion. Whether B-lines decrease in patients with acute heart failure by targeting therapy is not well known.

Methods: A multicenter, single-blind, ED-based, pilot trial randomized 130 patients to receive a 6-hour LUS-guided treatment strategy versus structured usual care. Patients were followed up throughout hospitalization and 90 days' postdischarge. B-lines ≤15 at 6 h was the primary outcome, and days alive and out of hospital (DAOOH) at 30 days was the main exploratory outcome.

Results: No significant difference in the proportion of patients with B-lines ≤15 at 6 hours (25.0% LUS vs 27.5% usual care; P = 0.83) or the number of B-lines at 6 hours (35.4 ± 26.8 LUS vs 34.3 ± 26.2 usual care; P = 0.82) was observed between groups. There were also no differences in DAOOH (21.3 ± 6.6 LUS vs 21.3 ± 7.1 usual care; P = 0.99). However, a significantly greater reduction in the number of B-lines was observed in LUS-guided patients compared with those receiving usual structured care during the first 48 hours (P = 0.04).

Conclusions: In this pilot trial, ED use of LUS to target pulmonary congestion conferred no benefit compared with usual care in reducing the number of B-lines at 6 hours or in 30 days DAOOH. However, LUS-guided patients had faster resolution of congestion during the initial 48 hours. (B-lines Lung Ultrasound-Guided ED Management of Acute Heart Failure Pilot Trial; NCT03136198).

Keywords: B-lines; acute heart failure; congestion; lung ultrasound.

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Conflict of interest statement

Funding Support and Author Disclosures Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R34HL136986. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Pang has received research funding from the Agency for Healthcare Research and Quality (AHRQ), the American Heart Association, BMS, Beckman Coulter, Ortho Diagnostics, and Roche over the last year. Roche provided in-kind support for biomarker analysis for this trial. Dr Ehrman has received research funding from GE Healthcare, CNA Diagnostics, and Blue Cross/Blue Shield of Michigan over the last year. Dr Russell has received research funding from GE Healthcare over the last year. Dr Collins has received research funding from the National Institutes of Health, the Patient-Centered Outcomes Research Institute, the Department of Defense, AHRQ, and Beckman Coulter; and consulting with Boehringer Ingelheim, Ortho Clinical, and Bristol Myers Squibb over the last year. Dr Levy has received research funding from the National Institutes of Health, the Patient-Centered Outcomes Research Institute, AHRQ, the Michigan Health Endowment Fund, Delta Dental, and Michigan Department of Health and Human Services, Cardiosounds, Edwards Lifesciences, Novartis, Pfizer, Siemens, and Beckman Coulter; and consulting with Baim Institute, Cardionomics, Ortho Clinical, Roche, Quidel, and the Michigan Public Health Institute over the last year. Dr Ferre has received consulting with Vave Healthcare, Inc; and course director for 3rd Rock Ultrasound, LLC over the last year. Dr Gargani has received research funding from the Italian Ministry of Health and Regione Toscana; and consultancy honoraria from GE Healthcare, Philips Healthcare, and Caption Health over the last year. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1:
Figure 1:. Study Treatment Algorithm
Recommended management for both LUS guided and usual structured care arms LUS = lung ultrasound, IV = intravenous, NIV = non-invasive ventilation. Figure reproduced with permission from Heart and Lung.
Figure 2:
Figure 2:. BLUSHED CONSORT Diagram
Flow of patients through each pre-defined study timepoint LUS = lung ultrasound, ER = emergency room
Central Illustration:
Central Illustration:. Comparison of Sum of B-lines throughout hospitalization
The primary endpoint of B-lines ≤ 15 at 6 hours was not achieved. Despite only 6 hours of protocolized therapy, LUS guided arm patients had less evidence of pulmonary congestion consistently throughout hospitalization
See this image and copyright information in PMC

Comment in

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