Kali R Romano1,2, Julia M Cory3, Juan J Ronco4, Gerald M Legiehn5, Jeffrey N Bone6, Gordon N Finlayson3,4. 1. Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, JPPN 2nd Floor, Room 2449 899 West 12th Ave, Vancouver, BC, V5Z 1M9, Canada. kali.romano@vch.ca. 2. Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada. kali.romano@vch.ca. 3. Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, JPPN 2nd Floor, Room 2449 899 West 12th Ave, Vancouver, BC, V5Z 1M9, Canada. 4. Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada. 5. Division of Interventional Radiology, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada. 6. Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Abstract
PURPOSE: Clinical equipoise exists with the use of novel reperfusion therapies such as catheter-directed thrombolysis in the management of patients presenting to hospital with high risk pulmonary embolism (PE). Therapeutic options rely on clinical presentation, patient factors, physician preference, and institutional availability. We established a Pulmonary Embolism Response Team (PERT) to provide urgent assessment and multidisciplinary care for patients presenting to our institution with high-risk PE. METHODS: Data were retrospectively collected from PERT activations between January 2016 and December 2018. Chi square tests were used to determine differences in mortality across the three years of study. Logistic regression was used to evaluate 30- and 90-day mortality and occurrence of major bleeds between those receiving anticoagulation alone (AC) and those receiving advanced reperfusion therapy (ART). RESULTS: There were 128 PERT activations over three years, the majority originating from the emergency department. Eighty-five percent of activations were for submassive PE, with 56% of all activations assessed as submassive-high risk. Fifteen patients (12%) presented with massive PE. Advanced reperfusion therapy was used in 29 (23%) patients, of whom 25 (20%) received catheter-directed thrombolysis. There was an increased risk of major bleeding in the ART group compared with in the AC group (odds ratio [OR], 17.9; 95% confidence interval [CI], 4.1 to 125.0; P < 0.001), but no increased risk of mortality at 30 days (OR, 2.1; 95% CI, 0.4 to 9.1; P = 0.3). The 30-day mortality rate was 7.8%. CONCLUSION: We describe the first Canadian PERT, a multidisciplinary team aimed at providing urgent individualized care for patients with high-risk PE. Further research is necessary to determine whether a PERT improves clinical outcomes.
PURPOSE: Clinical equipoise exists with the use of novel reperfusion therapies such as catheter-directed thrombolysis in the management of patients presenting to hospital with high risk pulmonary embolism (PE). Therapeutic options rely on clinical presentation, patient factors, physician preference, and institutional availability. We established a Pulmonary Embolism Response Team (PERT) to provide urgent assessment and multidisciplinary care for patients presenting to our institution with high-risk PE. METHODS: Data were retrospectively collected from PERT activations between January 2016 and December 2018. Chi square tests were used to determine differences in mortality across the three years of study. Logistic regression was used to evaluate 30- and 90-day mortality and occurrence of major bleeds between those receiving anticoagulation alone (AC) and those receiving advanced reperfusion therapy (ART). RESULTS: There were 128 PERT activations over three years, the majority originating from the emergency department. Eighty-five percent of activations were for submassive PE, with 56% of all activations assessed as submassive-high risk. Fifteen patients (12%) presented with massive PE. Advanced reperfusion therapy was used in 29 (23%) patients, of whom 25 (20%) received catheter-directed thrombolysis. There was an increased risk of major bleeding in the ART group compared with in the AC group (odds ratio [OR], 17.9; 95% confidence interval [CI], 4.1 to 125.0; P < 0.001), but no increased risk of mortality at 30 days (OR, 2.1; 95% CI, 0.4 to 9.1; P = 0.3). The 30-day mortality rate was 7.8%. CONCLUSION: We describe the first Canadian PERT, a multidisciplinary team aimed at providing urgent individualized care for patients with high-risk PE. Further research is necessary to determine whether a PERT improves clinical outcomes.
Authors: Jacob Schultz; Nicholas Giordano; Hui Zheng; Blair A Parry; Geoffrey D Barnes; Gustavo A Heresi; Wissam Jaber; Todd Wood; Thomas Todoran; D Mark Courtney; Soophia Naydenov; Sameer Khandhar; Philip Green; Christopher Kabrhel Journal: Pulm Circ Date: 2019-01-11 Impact factor: 3.017
Authors: Lukas Hobohm; Ioannis T Farmakis; Karsten Keller; Barbara Scibior; Anna C Mavromanoli; Ingo Sagoschen; Thomas Münzel; Ingo Ahrens; Stavros Konstantinides Journal: Clin Res Cardiol Date: 2022-08-17 Impact factor: 6.138