J Vasc Surg Venous Lymphat Disord. 2023 Mar 9:S2213-333X(23)00069-0. doi: 10.1016/j.jvsv.2023.03.002. Online ahead of print.
BACKGROUND: Pulmonary embolism (PE) is a major cause of mortality with presentation varying between few or no symptoms to sudden death. This makes timely and appropriate treatment extremely important. Multidisciplinary pulmonary embolism response teams (PERT) have emerged to improve the management of acute PE. This study aims to describe the experience of a large multi-hospital single-network institution with PERT.
METHODS: A retrospective cohort study of patients admitted for submassive and massive PE between 2012-2019 was conducted. The cohort was divided based on time of diagnosis and hospital into 2 groups: Non-PERT included patients treated at hospitals that did not initiate PERT and patients diagnosed prior to the introduction of PERT (June 1st, 2014); and the PERT group included those admitted after June 1st, 2014, to a hospital with PERT. Patients with low-risk PE and those who had admissions in both time periods were excluded. Primary outcomes included all-cause mortality at 30-, 60-, and 90-days. Secondary outcomes included causes of death, ICU admission, ICU length of stay (LOS), total hospital LOS, type of treatment, and specialty consultations.
RESULTS: 5,190 patients were analyzed, with 819 (15.8%) being in the PERT group. Patients in the PERT group were more likely to receive extensive workup that included troponin-I (66.3% vs. 42.3%; p<.001) and brain natriuretic peptide (50.4% vs. 20.3%; p<.001). They also more often received catheter directed interventions (12% vs. 6.2%; p<.001) rather than anticoagulation monotherapy. Mortality outcomes were similar between both groups at all measured timepoints. Rates of ICU admission (65.2% vs. 29.7%; p<.001), length of ICU stay (64.7 hours [41.9, 89.1] vs. 38 hours [22, 66.4]; p<.001), and total hospital LOS (5 [3, 8] vs. 4 [2, 6]; p<.001) were all higher among the PERT group. Patients in the PERT group were more likely to receive vascular surgery consultation (5.3% vs. 0.8%; p<.001) and the consultation occurred earlier in the admission when compared to the Non-PERT group (0 days [0, 1] vs. 1 day [0, 1]; p=.04).
CONCLUSION: The data presented here showed that there was no difference in mortality after PERT implementation. These results suggest that the presence of PERT increases the number of patients receiving a full PE workup with cardiac biomarkers. PERT also leads to more specialty consultations and more advanced therapies such as catheter directed interventions. Further research is needed to assess the effect of PERT on long-term survival of patients with massive and submassive PE.
PMID:36906104 | DOI:10.1016/j.jvsv.2023.03.002