Abstract:Background
Over the last years, multidisciplinary pulmonary embolism response teams (PERTs) have emerged to encounter the increasing variety and complexity in the management of acute pulmonary embolism (PE). We aimed to systematically investigate the composition and added clinical value of PERTs.
Methods
We searched PubMed, CENTRAL and Web of Science until January 2022 for articles designed to describe the structure and function of PERTs. We performed a ra… Show more
“…The percentage of OP treated by our local PERT (CELZAT) was higher than in other studies describing PERTs activity. Almost 34.5% (81/235) of our patients suffered from malignancy, whereas in the meta-analysis including 22 original studies and four surveys there was 23.5% OP [18]. The co-occurrence of malignancy and VTE is a sign of poor prognosis and mortality related to recurrent VTE, bleeding and the progress of neoplastic disease [19].…”
This study is a retrospective analysis of consecutive patients with venous thromboembolism (VTE) treated by the Pulmonary Embolism Response Team CELZAT (PERT-CELZAT) that compares the clinical characteristics, outcomes, and mortality of patients with and without cancer. It shows that patients with cancer can be successfully treated for pulmonary embolism (PE) with their in-hospital outcomes and mortality rate at the same level as patients without cancer. The study postulates that patients with PE, especially those in the intermediate and high-risk group or with contraindications for standard therapy, should be followed by a multidisciplinary team. This may result in lower complication rates and lower in-hospital mortality. However, the long-term follow-up shows that, despite successful treatment in the acute phase, the cancer patients had shorter survival times, which may be associated with the progression of neoplastic disease.
“…The percentage of OP treated by our local PERT (CELZAT) was higher than in other studies describing PERTs activity. Almost 34.5% (81/235) of our patients suffered from malignancy, whereas in the meta-analysis including 22 original studies and four surveys there was 23.5% OP [18]. The co-occurrence of malignancy and VTE is a sign of poor prognosis and mortality related to recurrent VTE, bleeding and the progress of neoplastic disease [19].…”
This study is a retrospective analysis of consecutive patients with venous thromboembolism (VTE) treated by the Pulmonary Embolism Response Team CELZAT (PERT-CELZAT) that compares the clinical characteristics, outcomes, and mortality of patients with and without cancer. It shows that patients with cancer can be successfully treated for pulmonary embolism (PE) with their in-hospital outcomes and mortality rate at the same level as patients without cancer. The study postulates that patients with PE, especially those in the intermediate and high-risk group or with contraindications for standard therapy, should be followed by a multidisciplinary team. This may result in lower complication rates and lower in-hospital mortality. However, the long-term follow-up shows that, despite successful treatment in the acute phase, the cancer patients had shorter survival times, which may be associated with the progression of neoplastic disease.
“…Als unterstützendes Verfahren kann die extrakorporale Membranoxygenierung Extrakorporale Membranoxygenierung (ECMO) eine Option zur Stabilisierung der Hämodynamik bis zur Wirkung der Reperfusionstherapie darstellen [ 5 , 16 ]. Die therapeutischen Optionen sollten in jedem Krankenhaus in einem interdisziplinären Lungenembolieteam Interdisziplinäres Lungenembolieteam („pulmonary embolism response team“ [PERT]) unter Berücksichtigung möglicher Kontraindikationen und der verfügbaren Ressourcen und Expertise erörtert werden, damit die am besten geeignete Therapie im Konsens gefunden und beschlossen werden kann [ 17 , 18 ].…”
Section: Therapie Bei Bestätigter Lungenembolieunclassified
Die Lungenembolie ist eine häufige kardiovaskuläre Erkrankung mit Abnahme der Mortalität, aber Zunahme der Inzidenz in den letzten Jahren. Dank der Optimierung klinischer Wahrscheinlichkeitsscores und der Interpretation des D‑Dimer-Tests können unnötige computertomographische Untersuchungen im Hinblick auf den Ausschluss einer akuten Lungenembolie vermieden werden – auch bei Schwangeren. Die Einschätzung des rechten Ventrikels trägt zu einer risikoadaptierten Behandlung bei. Die Behandlung besteht in einer Antikoagulation, allein oder in Kombination mit einer Reperfusionsbehandlung wie der systemischen Thrombolyse, aber auch der kathetergestützten oder operativen Therapie. Neben der Akuttherapie der Lungenembolie ist eine adäquate Nachsorge insbesondere zur Früherkennung von Langzeitfolgen wichtig. In diesem Übersichtsbeitrag werden aktuelle Empfehlungen internationaler Leitlinien für Patienten mit Lungenembolie zusammengefasst, durch klinische Fallbeispiele begleitet und kritisch diskutiert.
“…A limited number of studies have assessed the benefits of PE response team implementation. With regards to patient outcomes, the utilization of PE response teams has been associated with lower in-hospital mortality [ 26 ], 30-day mortality [ 26 ], and 6-month mortality by some studies, but not by others [ 27 , 28 , 29 , 30 , 31 ]. Furthermore, these findings cannot infer any cause-and-effect relationship between use of PE response teams and improved mortality rates given their observational design.…”
Section: Impact To Datementioning
confidence: 99%
“…The impact of PE response teams on length of stay (LOS) and cost of care has also been evaluated [ 31 ]. Care of PE patients is costly, with an average 3-day hospital LOS cost reported at $8764 [ 32 ].…”
Section: Impact To Datementioning
confidence: 99%
“…As for advanced therapies utilization, the results are consistent across studies. In studies performed at Massachusetts General Hospital, the University of Virginia Medical Center, and National University Hospital of Singapore, the use of advanced therapies, particularly catheter-directed therapies, increased, which may lead to an increased overall cost [ 27 , 28 , 31 , 41 ].…”
Pulmonary embolism (PE) continues to represent a significant health care burden and its incidence is steadily increasing worldwide. Constantly evolving therapeutic options and the rarity of randomized controlled trial data to drive clinical guidelines impose challenges on physicians caring for patients with PE. Recently, PE response teams have been developed and recommended to help address these issues by facilitating a consensus among local experts while advocating the management of acute PE according to each individual patient profile. In this review, we focus on the clinical challenges supporting the need for a PE response team, report the current evidence for their implementation, assess their impact on PE management and outcomes, and address unanswered questions and future directions.
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