Impact of a Pulmonary Embolism Response Team on the Management and Outcomes of Patients With Acute Pulmonary Embolisms
Nicole Russell1, Sameh Sayfo2, Timothy George2, Dennis Gable2
1Texas Christian University School of Medicine, Fort Worth, TX;2Baylor Scott & White Heart Hospital, Plano, TX
INTRODUCTION: Pulmonary embolism response teams (PERT) are multidisciplinary teams that specialize in rapid pulmonary embolism (PE) assessment and management. PERT teams are especially useful in the management of intermediate-risk PE patients due to a paucity of guideline recommendations, but their utilization and effectiveness varies considerably across institutions. At our institution, this team is comprised of vascular surgery, cardiothoracic surgery, cardiology, and pulmonary medicine.
METHODS: We retrospectively reviewed all patients presenting to our institution with a diagnosis of PE from July 2020 to April 2022. The primary outcome measures were in-hospital mortality, major bleeding events defined by the International Society on Thrombosis and Haemostasis (ISTH), and utilization of catheter-directed interventions (CDI). Secondary outcome measures included 30-day and 12-month mortality, hospital and intensive care unit (ICU) length of stay (LOS), vasopressor requirement, and cardiac arrest. Continuous variables were assessed with the Mann-Whitney U test and categorical variables were assessed with the chi-square or Fisher's exact test when appropriate.
RESULTS: Two hundred and seventy-nine patients with acute PE were identified with 79 (28%), 173 (62%), and 27 (10%) stratified as low-risk, intermediate-risk, and high-risk, respectively. There were 133 (47.7%) PERT activations. Saddle and main pulmonary artery embolisms [OR 3.6; 95% CI 2.2-6.0; P<0.001], RV strain [OR 2.2; 95% CI 1.4-3.6; P=0.001], RV dysfunction [OR 2.3; 95% CI 1.4-3.7; P<0.001], co-existing deep vein thrombosis [OR 2.7; 95% CI 1.7-4.4; P<0.001], and dyspnea as a presenting symptom [OR 2.1; 95% CI 1.2-3.6; P=0.008] were significant predictors of PERT activation. Patients evaluated by PERT were more likely to undergo CDI (49% vs. 27%, P<0.001, Fig. 1) across risk stratification, and less likely to have an IVC filter placed (1% vs. 5%, P=0.04). PERT consultation had numerical but not statistically significant trends toward less in-hospital (2% vs. 5%, P=0.2) and 30-day mortality (2% vs. 8%, P=0.06), but similar rates of 12-month mortality (7% vs. 8%, P=0.7). PERT activation also had a trend toward less major bleeding events (2% vs. 7%, P=0.09), cardiac arrest (2% vs. 7%, P=0.09), and reduced vasopressor requirement (9% vs. 18%, P=0.02). PERT was significantly associated with lower median ICU days (1.4 vs. 3.0, P=0.03), but median hospital LOS was the same between groups (3 vs. 3 days, P=0.5). CONCLUSIONS: At our institution, a multidisciplinary PERT team was associated with significantly higher utilization of CDIs, resulting in improved clinical outcomes such as less major bleeding events, and reduced in-hospital and 30-day mortality. Our results also demonstrate that PERT was associated with decreased vasopressor requirement and a decrease in ICU days, suggesting that PERT teams may have the potential to free hospital resources and reduce cost, although further research is needed to confirm that conclusion. Our data also suggests an advantage of a full multidisciplinary PERT team in institutions that treat this patient population.
Figure 1. CDI Utilization With and Without PERT 
Back to 2023 Abstracts