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

Frances Russell, Robert R. Ehrman, Robinson Ferre, Luna Gargani, Vicki Noble, Jordan Rupp, Sean P. Collins, Benton Hunter, Kathleen A. Lane, Phillip Levy, Xiaochun Li, Christopher O'Connor, Peter Pang

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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 30 days 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 90 days, 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.

Original languageEnglish (US)
JournalHeart and Lung
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Hospital Emergency Service
Heart Failure
Lung
Therapeutics
Clinical Protocols
Hospitalization
Mortality

Keywords

  • emergency department
  • Heart failure
  • Treatment
  • Ultrasound

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial. / Russell, Frances; Ehrman, Robert R.; Ferre, Robinson; Gargani, Luna; Noble, Vicki; Rupp, Jordan; Collins, Sean P.; Hunter, Benton; Lane, Kathleen A.; Levy, Phillip; Li, Xiaochun; O'Connor, Christopher; Pang, Peter.

In: Heart and Lung, 01.01.2018.

Research output: Contribution to journalArticle

Russell, Frances ; Ehrman, Robert R. ; Ferre, Robinson ; Gargani, Luna ; Noble, Vicki ; Rupp, Jordan ; Collins, Sean P. ; Hunter, Benton ; Lane, Kathleen A. ; Levy, Phillip ; Li, Xiaochun ; O'Connor, Christopher ; Pang, Peter. / Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial. In: Heart and Lung. 2018.
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AU - Gargani, Luna

AU - Noble, Vicki

AU - Rupp, Jordan

AU - Collins, Sean P.

AU - Hunter, Benton

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