The Resuscitationist - July 25, 2019 By Bowman J
..."In June of 2017 the REALITY AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) trial results were published in the Journal of the American College of Cardiology. In short they found a survival benefit (2.3% vs 6% mortality) to giving Lasix in the first 60 minutes of arrival to the ED. That’s an NNT of just 27! Better than aspirin in chest pain (NNT 43). Dun Dun Duuuuuunnnn….. Interesting. Salim Rezaie of RebelEM has a great review of the stats of the article. Essentially, it’s a prospective Japanese article of 20 hospitals looking at ADHF and the survival association of time to treatment with Lasix, excluding prehospital administration of Lasix. This was a pretty big undertaking to set up this registry and end up with something like 1200 patients enrolled, apparently us not giving Lasix early as much as we used to really pissed those medicine docs off. Now really though this is a Japanese study so I don’t know what the climate of Japanese EM Lasix administration was, from this study it seems like they gave it more than I’ve seen here in the US in a while. And this is actually a pretty good study question to answer, before this study we didn’t have any prospective outcome data on the temporal association of Lasix administration. Now this data exists. And apparently we should’ve been giving Lasix in the first 60 minutes. So oops right? Not so fast..."