Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes

Chaudhury, Pulkit; Gadre, Shruti; Schneider, Erika; Renapurkar, Rahul D.; Gomes, Marcelo; Haddadin, Ihab; Heresi, Gustavo A.; Tong, Michael Z.; Bartholomew, John R.

doi:10.1016/j.amjcard.2019.07.043

Cited by 131 publications

(96 citation statements)

References 18 publications

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“…Studies prior to COVID-19 have demonstrated that having a PERT decreases time to PE diagnosis, time to therapeutic anticoagulation, length of stay, and mortality. [20][21][22] During this pandemic, a central challenge to a PERT consultation is the awareness of the communicable nature of COVID-19 for those exposed to patients in the ICU, catheterization laboratory, or operating room. If not already performed, recommendation of a COVID-19 test should be done simultaneously with determination of hemodynamic stability.…”

Section: Diagnosis and Risk Stratificationmentioning

confidence: 99%

Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic

Rosovsky

Grodzin

Channick

et al. 2020

Chest

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The coexistence of coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE), two life-threatening illnesses, in the same patient presents a unique challenge. Guidelines have delineated how best to diagnose and manage patients with PE. However, the unique aspects of COVID-19 confound both the diagnosis and treatment of PE, and therefore require modification of established algorithms. Important considerations include adjustment of diagnostic modalities, incorporation of the prothrombotic contribution of COVID-19, management of two critical cardiorespiratory illnesses in the same patient, and protecting patients and health-care workers while providing optimal care. The benefits of a team-based approach for decision-making and coordination of care, such as that offered by pulmonary embolism response teams (PERTs), have become more evident in this crisis. The importance of careful follow-up care also is underscored for patients with these two diseases with long-term effects. This position paper from the PERT Consortium specifically addresses issues related to the diagnosis and management of PE in patients with COVID-19.

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Section: Diagnosis and Risk Stratificationmentioning

confidence: 99%

Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic

Rosovsky

Grodzin

Channick

et al. 2020

Chest

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“…Patients who are not hemodynamically stable due to shock or hypotension directly fall into the high-risk group. [11][12][13] When the mortality relationship of vital signs is examined, in the ınternational cooperative pulmonary embolism registry (ICOPER) study, the mortality in hemodynamically stable cases was found to be 15.1%, and 58.3% in unstable cases (hypotension and shock findings).…”

Section: Resultsmentioning

confidence: 99%

The effect of troponin values on prognosis in acute pulmonary embolism

Ilkhan¹,

Çelikhisar

2020

Int J Clin Trials

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Background: The objective of this study is to evaluate the clinical usefulness of cardiac troponin levels in acute pulmonary thromboembolism (PTE) prognosis.Methods: Thorax computed tomography (CT) angiography was performed and reported by the radiologist as pulmonary embolism and 193 patients older than 18 years of age who were considered PTE by the physician of chest diseases were included in the study. Patients diagnosed with PTE were divided into two groups as those who died within 30 days and did not die within 30 days. As a result of the statistically significant relationship between troponin and mortality, receiver operating characteristic (ROC) analysis was performed to determine the prognosis level of troponin and appropriate sensitivity and specificity cut-off values were determined.Results: We determined that troponin levels of patients diagnosed with PTE in the emergency department were statistically significantly higher in the group with mortality (p=0.031). Since the area under the curve (AUC) value was calculated as 0.636, troponin value was found to have a weak-medium significance in terms of predicting 30-day mortality.Conclusions: Troponin values are statistically significantly higher in patients with a one-month period than the survivor group in this period. However, we concluded that troponin values are not clinically usable as mortality markers due to their low sensitivity and specificity rates. However, due to its significant relationship with increased mortality, patients with PTE with high troponin values should be hospitalized and monitored closely.

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“…This treatment has the potential to improve right ventricular function by relieving elevated pulmonary vascular pressures and stabilizing hemodynamics [33]. A pulmonary embolism response team can help decide on the best therapy for a patient with acute PE [57][58][59]. Endovascular therapy can be considered in patients with contraindications to systemic thrombolysis who have submassive acute PE, evidenced by elevated troponin and brain natriuretic peptide, and right heart strain [33,60,61].…”

Section: Endovascular Treatment Of Acute Pementioning

confidence: 99%

Acute pulmonary embolism multimodality imaging prior to endovascular therapy

Sin

McLennan

Rengier

et al. 2020

Int J Cardiovasc Imaging

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The manuscript discusses the application of CT pulmonary angiography, ventilation-perfusion scan, and magnetic resonance angiography to detect acute pulmonary embolism and to plan endovascular therapy. CT pulmonary angiography offers high accuracy, speed of acquisition, and widespread availability when applied to acute pulmonary embolism detection. This imaging modality also aids the planning of endovascular therapy by visualizing the number and distribution of emboli, determining ideal intra-procedural catheter position for treatment, and signs of right heart strain. Ventilation-perfusion scan and magnetic resonance angiography with and without contrast enhancement can also aid in the detection and pre-procedural planning of endovascular therapy in patients who are not candidates for CT pulmonary angiography.

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Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes

Cited by 131 publications

References 18 publications

Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic

Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic

The effect of troponin values on prognosis in acute pulmonary embolism

Acute pulmonary embolism multimodality imaging prior to endovascular therapy

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