PT - JOURNAL ARTICLE AU - Arvig, Michael Dan AU - Lassen, Annmarie Touborg AU - Gæde, Peter Haulund AU - Gärtner, Stefan Wernblad AU - Falster, Casper AU - Skov, Inge Raadal AU - Petersen, Henrik Ømark AU - Posth, Stefan AU - Laursen, Christian B TI - Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomised, controlled trial AID - 10.1136/emermed-2022-212694 DP - 2023 Oct 01 TA - Emergency Medicine Journal PG - 700--707 VI - 40 IP - 10 4099 - http://emj.bmj.com/content/40/10/700.short 4100 - http://emj.bmj.com/content/40/10/700.full SO - Emerg Med J2023 Oct 01; 40 AB - Background Serial point-of-care ultrasound (PoCUS) can potentially improve acute patient care through treatment adjusted to the dynamic ultrasound findings. The objective was to investigate if treatment guided by monitoring patients with acute dyspnoea with serial cardiopulmonary PoCUS and usual care could reduce the severity of dyspnoea compared with usual care alone.Methods This was a randomised, controlled, blinded-outcome trial conducted in three EDs in Denmark between 9 October 2019 and 26 May 2021. Patients aged ≥18 years admitted with a primary complaint of dyspnoea were allocated 1:1 with block randomisation to usual care, which included a single cardiopulmonary PoCUS within 1 hour of arrival (control group) or usual care (including a PoCUS within 1 hour of arrival) plus two additional PoCUS performed at 2 hours interval from the initial PoCUS (serial ultrasound group). The primary outcome was a reduction of dyspnoea measured on a verbal dyspnoea scale (VDS) from 0 to 10 recorded at inclusion and after 2, 4 and 5 hours.Results There were 206 patients recruited, 102 in the serial ultrasound group and 104 in the control group, all of whom had complete follow-up. The mean difference in VDS between patients in the serial ultrasound and the control group was −1.09 (95% CI −1.51 to −0.66) and −1.66 (95% CI −2.09 to −1.23) after 4 and 5 hours, respectively. The effect was more pronounced in patients with a presumptive diagnosis of acute heart failure (AHF). A larger proportion of patients received diuretics in the serial ultrasound group.Conclusion Therapy guided by serial cardiopulmonary PoCUS may, together with usual care, facilitate greater improvement in the severity of dyspnoea, especially in patients with AHF compared with usual care with a single PoCUS in the ED. Serial PoCUS should therefore be considered for routine use to aid the physician in stabilising the patient faster.Trial registration number NCT04091334.Data are available on reasonable request. De-identified participant data may be made available on request to the corresponding author if data sharing is in accordance with applicable legislation on the processing of personal data (GDPR and the Danish Data Protection Act). Data will be provided through a secured mailing address. Data can be requested after publication and until 31 December 2022, on which data will be deleted or transferred to Danish National Archives according to Danish legislation. Data can only be reused after acceptance from MDA, ATL, PHG and CBL.