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. 2020 Nov;133(11):1313-1321.e6.
doi: 10.1016/j.amjmed.2020.03.058. Epub 2020 May 19.

Changes in Care for Acute Pulmonary Embolism Through A Multidisciplinary Pulmonary Embolism Response Team

Brett J Carroll  1 , Sebastian E Beyer  2 , Tyler Mehegan  2 , Andrew Dicks  2 , Abby Pribish  2 , Andrew Locke  3 , Anuradha Godishala  3 , Kevin Soriano  2 , Jaya Kanduri  2 , Kelsey Sack  2 , Inbar Raber  2 , Cara Wiest  2 , Isabel Balachandran  2 , Mason Marcus  2 , Louis Chu  4 , Margaret M Hayes  5 , Jeff L Weinstein  6 , Kenneth A Bauer  7 , Eric A Secemsky  2 , Duane S Pinto  2
Affiliations

Changes in Care for Acute Pulmonary Embolism Through A Multidisciplinary Pulmonary Embolism Response Team

Brett J Carroll et al. Am J Med. 2020 Nov.

Abstract

Background: Optimal management of acute pulmonary embolism requires expertise offered by multiple subspecialties. As such, pulmonary embolism response teams (PERTs) have increased in prevalence, but the institutional consequences of a PERT are unclear.

Methods: We compared all patients that presented to our institution with an acute pulmonary embolism in the 3 years prior to and 3 years after the formation of our PERT. The primary outcome was in-hospital pulmonary embolism-related mortality before and after the formation of the PERT. Sub-analyses were performed among patients with elevated-risk pulmonary embolism.

Results: Between August 2012 and August 2018, 2042 patients were hospitalized at our institution with acute pulmonary embolism, 884 (41.3%) pre-PERT implementation and 1158 (56.7%) post-PERT implementation, of which 165 (14.2%) were evaluated by the PERT. There was no difference in pulmonary embolism-related mortality between the two time periods (2.6% pre-PERT implementation vs 2.9% post-PERT implementation, P = .89). There was increased risk stratification assessment by measurement of cardiac biomarkers and echocardiograms post-PERT implementation. Overall utilization of advanced therapy was similar between groups (5.4% pre-PERT implementation vs 5.4% post-PERT implementation, P = 1.0), with decreased use of systemic thrombolysis (3.8% pre-PERT implementation vs 2.1% post-PERT implementation, P = 0.02) and increased catheter-directed therapy (1.3% pre-PERT implementation vs 3.3% post-PERT implementation, P = 0.05) post-PERT implementation. Inferior vena cava filter use decreased after PERT implementation (10.7% pre-PERT implementation vs 6.9% post-PERT implementation, P = 0.002). Findings were similar when analyzing elevated-risk patients.

Conclusion: Pulmonary embolism response teams may increase risk stratification assessment and alter application of advanced therapies, but a mortality benefit was not identified.

Keywords: Catheter-directed thrombolysis; Inferior vena cava filters, Pulmonary embolism, Response teams, Systemic thrombolysis.

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Conflict of interest statement

Conflict of Interest: DSP is a consultant for Abbott Vascular, Abiomed, Boston Scientific, Medtronic, NuPulseCV, and Teleflex. KAB has served as a consultant for Bristol Myers Squibb. EAS has received research grants to BIDMC: AstraZeneca, BD Bard, Boston Scientific, Cook Medical, CSI, Medtronic, Philips, and the University of California, San Francisco; is a consultant for BD Bard, CSI, Janssen, Medtronic, and Philips; and is on the speaking bureau for BD Bard, Cook Medical, and Medtronic. The remaining authors have no relevant disclosures.

Figures

Figure 1
Figure 1
Outcomes in all patients admitted with an acute pulmonary embolism before and after PERT implementation. IVC = inferior vena cava; PERT = pulmonary embolism response team.
Figure 2
Figure 2
Outcomes in elevated-risk patients with an acute pulmonary embolism before and after PERT implementation. IVC = inferior vena cava; PERT = pulmonary embolism response team.
See this image and copyright information in PMC

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