Supplemental Digital Content is available in the text.

Background We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions ( P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions ( P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability.

No abstract

Acute pulmonary embolism (PE) is the third most common cardiovascular cause of death after acute myocardial infarction and stroke. Patients are, however, often under-treated due to the risks associated with systemic thrombolysis and surgical embolectomy. Novel pharmacological and catheter-based treatment strategies show promise, but the data supporting their use in patients are sparse. We therefore aimed to develop an in vivo model of acute PE enabling controlled evaluations of efficacy and safety of novel therapies. Danish Landrace pigs (n = 8) were anaesthetized and mechanically ventilated. Two pre-formed autologous PEs (PE1, PE2, 20 × 1 cm) were administered consecutively via the right external jugular vein. The intact nature and central location were visualized in situ by magnetic resonance imaging (MRI). The hemodynamic and biochemical responses were evaluated at baseline (BL) and after each PE by invasive pressure measurements, MRI, plus arterial and venous blood analysis. Pulmonary arterial pressure increased after administration of the PEs (BL: 16.3 ± 1.2, PE1: 27.6 ± 2.9, PE2: 31.6 ± 3.1 mmHg, BL vs. PE1: P = 0.0027, PE1 vs. PE2: P = 0.22). Animals showed signs of right ventricular strain evident by increased end systolic volume (BL: 60.9 ± 5.1, PE1: 83.3 ± 5.0, PE2: 99.4 ± 6.5 mL, BL vs. PE1: P = 0.0005, PE1 vs. PE2: P = 0.0045) and increased plasma levels of Troponin T. Ejection fraction decreased (BL: 58.9 ± 2.4, PE1: 46.4 ± 2.9, PE2: 37.3 ± 3.5%, BL vs. PE1: p = 0.0008, PE1 vs. PE2: P = 0.009) with a compensatory increase in heart rate preserving cardiac output and systemic blood pressure. The hemodynamic and biochemical responses were comparable to that of patients suffering from intermediate-high-risk PE. This porcine model mirrors the anatomical and physiologic changes seen in human patients with intermediate-high-risk PE, and may enable testing of future therapies for this disease.

Background/objectiveSignificant biomechanical differences were found among deadlift variations. However, little is known about the differences between the conventional and the Romanian deadlifts. Therefore, the purpose of this study was to determine which deadlift technique is a better training protocol between the conventional and the Romanian deadlifts as indicated by the greater demand in muscle activities and joint kinetics.Methods21 males performed each deadlift with 70% of the Romanian deadlift one repetition maximum (1RM) determined using a 1RM testing. Myoelectric activities of the rectus femoris, biceps femoris, and gluteus maximus and lower extremity net joint torque (NJT) were compared. The variables were extracted through an electromyography system (EMG) and a three-dimensional motion analysis. The EMG values were normalized to the peak EMG activation from a submaximal non-isometric voluntary contraction. A two-way repeated measures analysis of variance was conducted for statistical analysis. The level of significance was set at 0.05.ResultsSignificantly greater normalized EMG values were found from the rectus femoris and gluteus maximus (58.57 ± 13.73 and 51.52 ± 6.08 %peak) of the conventional deadlift than those of the Romanian deadlift (25.26 ± 14.21 and 46.88 ± 7.39 %peak). The conventional deadlift indicated significantly greater knee and ankle NJTs (0.21 ± 0.13 and −0.33 ± 0.08 Nm/kg cm) than those of the Romanian deadlift (−0.28 ± 0.1 and −0.29 ± 0.06 Nm/kg cm).ConclusionThe conventional deadlift would be a better technique for training the rectus femoris and gluteus maximus than the Romanian deadlift as indicated by the greater EMG and NJT values.