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. 2021 Aug;26(4):426-433.
doi: 10.1177/1358863X21995896. Epub 2021 Apr 4.

Pulmonary Embolism Response Team utilization during the COVID-19 pandemic

Matthew T Finn  1   2 , Shawn Gogia  1 , Joseph J Ingrassia  3 , Matthew Cohen  1 , Mahesh V Madhavan  1   2 , Shayan Nabavi Nouri  1 , Yevgeniy Brailovsky  1 , Amir Masoumi  1 , Justin A Fried  1 , Nir Uriel  1   2 , Cara I Agerstrand  4 , Andrew Eisenberger  5 , Andrew J Einstein  1 , Daniel Brodie  4 , Erika B Rosenzweig  1   6 , Martin B Leon  1   2 , Koji Takeda  7 , Anthony Pucillo  1 , Philip Green  1 , Ajay J Kirtane  1   2 , Sahil A Parikh  1   2 , Sanjum S Sethi  1   2
Affiliations

Pulmonary Embolism Response Team utilization during the COVID-19 pandemic

Matthew T Finn et al. Vasc Med. 2021 Aug.

Abstract

Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE). Limited data are available on the utilization of the Pulmonary Embolism Response Team (PERT) in the setting of the COVID-19 global pandemic. We performed a single-center study to evaluate treatment, mortality, and bleeding outcomes in patients who received PERT consultations in March and April 2020, compared to historical controls from the same period in 2019. Clinical data were abstracted from the electronic medical record. The primary study endpoints were inpatient mortality and GUSTO moderate-to-severe bleeding. The frequency of PERT utilization was nearly threefold higher during March and April 2020 (n = 74) compared to the same period in 2019 (n = 26). During the COVID-19 pandemic, there was significantly less PERT-guided invasive treatment (5.5% vs 23.1%, p = 0.02) with a numerical but not statistically significant trend toward an increase in the use of systemic fibrinolytic therapy (13.5% vs 3.9%, p = 0.3). There were nonsignificant trends toward higher in-hospital mortality or moderate-to-severe bleeding in patients receiving PERT consultations during the COVID-19 period compared to historical controls (mortality 14.9% vs 3.9%, p = 0.18 and moderate-to-severe bleeding 35.1% vs 19.2%, p = 0.13). In conclusion, PERT utilization was nearly threefold higher during the COVID-19 pandemic than during the historical control period. Among patients evaluated by PERT, in-hospital mortality or moderate-to-severe bleeding were not significantly different, despite being numerically higher, while invasive therapy was utilized less frequently during the COVID-19 pandemic.

Keywords: COVID-19; SARS-CoV-2; pulmonary embolism response team (PERT); venous thromboembolism.

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Conflict of interest statement

Declaration of conflicting interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Masoumi has received speaking honoraria from Abiomed Inc. Dr Einstein reports no relevant activities related to the present article; consultant for GE Healthcare and W. L. Gore & Associates; institution has grants/grants pending from the National Institutes of Health, International Atomic Energy Agency, Canon Medical Systems, Roche Medical Systems, and W. L. Gore & Associates; received travel/accommodations/meeting expenses unrelated to activities listed from HeartFlow. Dr Uriel is a consultant to Thoratec, HeartWare International, and Abiomed; received grant support from HeartWare International; has previously received grant support from and has been a consultant to Medtronic and Abbott. Dr Brodie receives grant support and consultative fees from Maquet and Baxter; has previously received research support from ALung Technologies and has served on the medical advisory boards of ALung Technologies, Baxter, BREETHE, Xenios, and Hemovent. Dr Leon receives grant support, paid to his institution, and advisory board fees from Medtronic and Abbott; receiving grant support, paid to his institution, and advisory board fees from and holding equity in Boston Scientific; receiving advisory board fees from Gore Medical; and receiving advisory fees from Meril Life Sciences; has previously received grant support research grants from Abbott Vascular, Boston Scientific, Medtronic, Biosensors, and Sinomed; Equity in Medinol. Dr Kirtane has received support from institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, and ReCor Medical. In addition to research grants, institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for speaking engagements and/or consulting; (personal) consulting: Neurotronics; travel expenses/meals from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. Dr Parikh has received institutional grants/research support from Abbott Vascular, ShockWave Medical, TriReme Medical, Sumodics, Silk Road Medical, and the National Institutes of Health; has received consulting fees from Terumo and Abiomed; has previously served on the advisory boards of Abbott, Medtronic, Boston Scientific, Cardiovascular Systems, Inc., CSI, Janssen, and Philips and has served as a consultant for Terumo and Asahi. Dr Sethi reports honoraria from Janssen and Chiesi. The remaining authors have nothing to disclose.

Figures

Figure 1.
Figure 1.
PERT consult volume March – April 2019 versus 2020 compared to New York City COVID-19 diagnoses. Note: Total New York COVID-19 positive cases represent a 7-day rolling average. Data obtained from NYC.gov (last access May 17, 2020). NYC, New York City; PERT, pulmonary embolism response team.
Figure 2.
Figure 2.
PERT venous thromboembolism treatments. COVID era: March-April 2020. COVID, coronavirus disease; ECMO, extracorporeal membrane oxygenation; PERT, pulmonary embolism response team; TPA, tissue plasminogen activator; Tx, thrombectomy.
Figure 3.
Figure 3.
Major outcomes with PERT consultation. COVID era: March-April 2020. Note: ‘remain inpatient’ represents the percentage of patients who were still hospitalized as of the closure of the dataset on May 3, 2020. COVID, coronavirus disease; CT, computed tomography; Dx, diagnosis; GUSTO, Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries; Mod, moderate; PERT, pulmonary embolism response team.
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