Lung ultrasound in ED to manage acute HF confers no benefit
A strategy of care based on lung ultrasound in the ED for pulmonary congestion in acute HF showed no benefit in reducing B-line numbers compared with usual care, according to new study findings.

The goal of this study was to determine whether a 6-h 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.

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.

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

-- No significant difference in the proportion of patients with B-lines less than 15 at 6 h (25.0% LUS vs 27.5% usual care) or the number of B-lines at 6 h (35.4 ± 26.8 LUS vs 34.3 ± 26.2 usual care) was observed between groups.

-- There were also no differences in DAOOH (21.3 ± 6.6 LUS vs 21.3 ± 7.1 usual care).

-- 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 h.

Conclusively, 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 h or in 30 d’ DAOOH. However, LUS-guided patients had faster resolution of congestion during the initial 48 h.