Aleksander Araszkiewicz1, Marcin Kurzyna2, Grzegorz Kopeć3,4, Sylwia Sławek-Szmyt5, Katarzyna Wrona2, Jakub Stępniewski3,4, Stanisław Jankiewicz1, Arkadiusz Pietrasik6, Michał Machowski7, Szymon Darocha2, Tatiana Mularek-Kubzdela1, Adam Torbicki2, Piotr Pruszczyk7, Marek Roik7. 1. 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland. 2. Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Center in Otwock, Medical Center for Postgraduate Education, Otwock, Poland. 3. Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland. 4. John Paul II Hospital, Kraków, Poland. 5. 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland. sylwia.slawek@skpp.edu.pl. 6. Department and Faculty of Cardiology, Medical University of Warsaw, Warszawa, Poland. 7. Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland.
Abstract
BACKGROUND: A pulmonary embolism response team (PERT) is a multidisciplinary team established to improve clinical care for patients with pulmonary embolism (PE). However, data regarding detailed institutional experience and clinical outcomes from such teams are sparse. AIMS: We aim to assess the frequency of activations, patients' characteristics, PE severity, applied treatments, and outcomes of PE patients treated by Polish PERTs. METHODS: The survey registry was conducted between June 2018 and July 2020. All consecutive PERT activations of four institutionalized PERTs in Poland were analyzed. Patients' characteristics, therapies applied, and in-hospital outcomes were evaluated. RESULTS: There were 680 unique PERT activations. Most activations originated from Emergency Departments (44.9%), and the remaining originated from internal medicine/cardiology units (31.1%), surgery/orthopedics (9.1 %), oncology (6.3%), intensive care units (6.0%), and others (2.5%). The origin of activation varied significantly among institutions (P <0.01). Most PERT cases were patients with intermediate-high risk PE (42.9%), whereas high-risk PE occurred in 10% of patients. Anticoagulation alone was delivered to 80.3% of patients, and 23.3% of patients received at least one advanced therapy: catheter-directed therapies (11.3%), systemic thrombolysis (5.3%), surgical embolectomy (2.4%), vena cava filter placement (3.7%), and extracorporeal membrane oxygenation (0.6%). In-hospital mortality in the whole study group was 5.1%, with significant differences between institutions (P = 0.01). CONCLUSIONS: The frequency of PE severity, type of delivered catheter-directed treatment, and in-hospital mortality vary between institutions without significant discrepancies in PERT activations. This variation between expert centers highlights the local differences in PERTs' organizational and operational forms.
BACKGROUND: A pulmonary embolism response team (PERT) is a multidisciplinary team established to improve clinical care for patients with pulmonary embolism (PE). However, data regarding detailed institutional experience and clinical outcomes from such teams are sparse. AIMS: We aim to assess the frequency of activations, patients' characteristics, PE severity, applied treatments, and outcomes of PE patients treated by Polish PERTs. METHODS: The survey registry was conducted between June 2018 and July 2020. All consecutive PERT activations of four institutionalized PERTs in Poland were analyzed. Patients' characteristics, therapies applied, and in-hospital outcomes were evaluated. RESULTS: There were 680 unique PERT activations. Most activations originated from Emergency Departments (44.9%), and the remaining originated from internal medicine/cardiology units (31.1%), surgery/orthopedics (9.1 %), oncology (6.3%), intensive care units (6.0%), and others (2.5%). The origin of activation varied significantly among institutions (P <0.01). Most PERT cases were patients with intermediate-high risk PE (42.9%), whereas high-risk PE occurred in 10% of patients. Anticoagulation alone was delivered to 80.3% of patients, and 23.3% of patients received at least one advanced therapy: catheter-directed therapies (11.3%), systemic thrombolysis (5.3%), surgical embolectomy (2.4%), vena cava filter placement (3.7%), and extracorporeal membrane oxygenation (0.6%). In-hospital mortality in the whole study group was 5.1%, with significant differences between institutions (P = 0.01). CONCLUSIONS: The frequency of PE severity, type of delivered catheter-directed treatment, and in-hospital mortality vary between institutions without significant discrepancies in PERT activations. This variation between expert centers highlights the local differences in PERTs' organizational and operational forms.
Entities:
Keywords:
anticoagulation; catheter-directed therapy; pulmonary embolism; pulmonary embolism response team
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