Author + information
- Colin Wright,
- Ayman Elbadawi,
- Yu Lin Chen,
- Dhwani Patel,
- Joseph Delehanty,
- Justin Mazzillo,
- Anthony Pietropaoli,
- Igor Gosev and
- Scott Cameron
The concept of a Pulmonary Embolism Response Team (PERT) is multidisciplinary, with the hope that it may positively impact patient care, hospital efficiency, and outcomes in the treatment of patients with intermediate and high risk pulmonary embolism (PE).
Clinical characteristics of a baseline population of patients presenting with intermediate and high risk PE to URMC between 2014 and 2016 were examined (n=284). We compared this baseline population before implementation of a PERT to a similar population of patients 15 months after PERT implementation (n=92). Outcomes include management strategies, efficiency of the emergency department (ED) in identifying, treating, and dispositioning patients, and mortality.
PERT was activated 148 times (69% in the ED and 31% in-patient) in 15 months. Before PERT, patients with submassive and massive PE were managed fairly conservatively: heparin alone (92%), systemic thrombolytic therapy (3%), and IVC filter (5%). Following PERT, submassive and massive PE were managed as follows: heparin alone (62%), systemic thrombolysis (7%), catheter-directed lytic therapy (10%), IVC filter (7%), extra-corporeal membranous oxygenation (ECMO) (4%), surgical embolectomy (3%) and thromboendarterectomy (1%), and suction thrombectomy (2%). Efficiency of the ED in managing high risk PE significantly improved after PERT compared with before PERT; where triage to diagnosis time was reduced (441 vs. 256 minutes, 42% decrease, p=0.0014), diagnosis to heparin time was reduced (194 vs. 84 minutes, 56% decrease, p=0.009), and the duration of ED boarding was reduced (410 vs. 251 minutes, 38% decrease, P<0.001). There was a trend towards improved mortality in ED patients after PERT compared to before PERT (16% vs. 23%, RR 0.70 at 3 months, and 20% vs 27%, RR 0.74 at 6 months).
Our analysis showed that following PERT implementation, patients with intermediate and high risk acute PE received more aggressive and advanced treatment modalities and received more efficient patient care, and had a trend towards decreased mortality compared to before PERT. Variables accounting for mortality reduction remain to be determined.
Poster Hall, Hall F
Saturday, March 16, 2019, 3:45 p.m.-4:30 p.m.
Session Title: Pulmonary Hypertension and Venous Thrombo-Embolic Disease 2
Abstract Category: 35. Pulmonary Hypertension and Venous Thrombo-embolic Disease
Presentation Number: 1185-493
- 2019 American College of Cardiology Foundation