Assessing the Impact of a Pulmonary Embolism Response Team and Treatment Protocol on Patients Presenting With Acute Pulmonary Embolism

Jen, Wei-Ying; Kristanto, William; Teo, Lynette; Phua, Jason; Yip, Hwee Seng; MacLaren, Graeme; Teoh, Kristine; Sim, Terence; Loh, Joshua P.; Ong, Ching Ching; Chee, Yen Lin; Kojodjojo, Pipin

doi:10.1016/j.hlc.2019.02.190

Cited by 31 publications

(30 citation statements)

References 17 publications

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“…Our analysis of consecutive patients treated for acute PE in 2 distinct eras eliminates the bias introduced by construction of artificial comparator groups. In a third study reporting on survival pre-and post-PERT, Jen et al evaluated only in-hospital mortality, which is a relatively short time scale and may not reflect the true survival benefit which appears to accrue with time as demonstrated in our analysis [10].…”

Section: Discussionmentioning

confidence: 80%

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Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism

et al. 2020

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Background: Acute pulmonary embolism remains a significant cause of mortality and morbidity worldwide. Benefit of recently developed multidisciplinary PE response teams (PERT) with higher utilization of advanced therapies has not been established. Methods: To evaluate patient-centered outcomes and cost-effectiveness of a multidisciplinary PERT we performed a retrospective analysis of 554 patients with acute PE at the university of Virginia between July 2014 and June 2015 (pre-PERT era) and between April 2017 through October 2018 (PERT era). Six-month survival, hospital length-of-stay (LOS), type of PE therapy, and in-hospital bleeding were assessed upon collected data. Results: 317 consecutive patients were treated for acute PE during an 18-month period following institution of a multidisciplinary PE program; for 120 patients PERT was activated (PA), the remaining 197 patients with acute PE were considered as a separate, contemporary group (NPA). The historical, comparator cohort (PP) was composed of 237 patients. These 3 groups were similar in terms of baseline demographics, comorbidities and risk, as assessed by the Pulmonary Embolism Severity Index (PESI). Patients in the historical cohort demonstrated worsened survival when compared with patients treated during the PERT era. During the PERT era no statistically significant difference in survival was observed in the PA group when compared to the NPA group despite significantly higher severity of illness among PA patients. Hospital LOS was not different in the PA group when compared to either the NPA or PP group. Hospital costs did not differ among the 3 cohorts. 30-day re-admission rates were significantly lower during the PERT era. Rates of advanced therapies were significantly higher during the PERT era (9.1% vs. 2%) and were concentrated in the PA group (21.7% vs. 1.5%) without any significant rise in in-hospital bleeding complications.

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Section: Discussionmentioning

confidence: 80%

“…These findings are in accord with previously published data. Across studies, an increase in bleeding rates has not been observed despite increased utilization of therapies thought to carry a higher risk of bleeding [7,10]. This lower bleeding rate may be attributable to better patient selection, less use of heparin infusions and warfarin.…”

Section: Discussionmentioning

confidence: 99%

Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism

et al. 2020

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“…The searches yielded 2119 citations, 1794 from databases and 325 from grey literature search citations. After duplicates were removed, 1545 studies underwent title and abstract review, after which 22 studies remained [5,6,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Of these studies, six were excluded after reviewing the full-text manuscript.…”

Section: Resultsmentioning

confidence: 99%

Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis

et al. 2022

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BackgroundThe impact of pulmonary embolism response teams (PERTs) on treatment choice and outcomes of patients with acute pulmonary embolism (PE) is still uncertain.ObjectiveTo determine the effect of PERTs in the management and outcomes of patients with PE.MethodsPubMed, Embase, Web of Science, CINAHL, WorldWideScience and MedRxiv were searched for original articles reporting PERT patient outcomes from 2009. Data were analysed using a random effects model.Results16 studies comprising 3827 PERT patients and 3967 controls met inclusion criteria. The PERT group had more patients with intermediate and high-risk PE (66.2%) compared to the control group (48.5%). Meta-analysis demonstrated an increased risk of catheter-directed interventions, systemic thrombolysis and surgical embolectomy (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.74–2.53; p<0.01), similar bleeding complications (OR 1.10, 95% CI 0.88–1.37) and decreased utilisation of inferior vena cava (IVC) filters (OR 0.71, 95% CI 0.58–0.88; p<0.01) in the PERT group. Furthermore, there was a nonsignificant trend towards decreased mortality (OR 0.87, 95% CI 0.71–1.07; p=0.19) with PERTs.ConclusionsThe PERT group showed an increased use of advanced therapies and a decreased utilisation of IVC filters. This was not associated with increased bleeding. Despite comprising more severe PE patients, there was a trend towards lower mortality in the PERT group.

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“…Several recent studies analyzing the efficacy of PERTs have shown a significant increase in the utilization of STT and CDTs in massive PE and a decrease in intensive care unit length of stay and decrease in elapsed time from diagnosis to therapeutic anticoagulation following the creation of a PERT without a change in major bleeding or overall cost. 22,42,[54][55][56][57] PERTs also demonstrate a significant decrease in 30-day inpatient mortality when compared to hospitals without such (8.5% vs 4.7%, p = 0.03) [54][55][56] Many hospitals do not have the comprehensive surgical or endovascular facilities to implement the therapy indicated by a PERT compared to technically simpler STT and anticoagulation. 58 Due to system limitations, many facilities elect to use a bridging therapy to transfer acute PE patients to a referral center with capabilities of CDT and or surgical thrombectomy.…”

Section: Improving Acute Pe Management By a Team Approachmentioning

confidence: 99%

Evolving Management Trends and Outcomes in Catheter Management of Acute Pulmonary Embolism

Lewis

Gerstein

Venkataramani

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Assessing the Impact of a Pulmonary Embolism Response Team and Treatment Protocol on Patients Presenting With Acute Pulmonary Embolism

Cited by 31 publications

References 17 publications

Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism

Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism

Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis

Evolving Management Trends and Outcomes in Catheter Management of Acute Pulmonary Embolism

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