Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience

• Published in: Canadian journal of anesthesia Vol. 67; no. 12; pp. 1806 - 1813
• Main Authors: Romano, Kali R., Cory, Julia M., Ronco, Juan J., Legiehn, Gerald M., Bone, Jeffrey N., Finlayson, Gordon N.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2020; Springer Nature B.V
• Subjects: Anesthesiology; Canada; Cardiology; Case Reports; Case Series; Catheters; Critical Care Medicine; Hospitals, General; Humans; Intensive; Medicine; Medicine & Public Health; Mortality; Pain Medicine; Patient Care Team; Pediatrics; Pneumology/Respiratory System; Pulmonary Embolism - therapy; Pulmonary embolisms; Retrospective Studies; Thrombolytic drugs; Canada; pulmonary embolism; response team
• ISSN: 0832-610X; 1496-8975; 1496-8975
• DOI: 10.1007/s12630-020-01790-6

Purpose Clinical equipoise exists with the use of novel reperfusion therapies such as catheter-directed thrombolysis in the management of patients presenting to hospital with high risk pulmonary embolism (PE). Therapeutic options rely on clinical presentation, patient factors, physician preference, and institutional availability. We established a Pulmonary Embolism Response Team (PERT) to provide urgent assessment and multidisciplinary care for patients presenting to our institution with high-risk PE. Methods Data were retrospectively collected from PERT activations between January 2016 and December 2018. Chi square tests were used to determine differences in mortality across the three years of study. Logistic regression was used to evaluate 30- and 90-day mortality and occurrence of major bleeds between those receiving anticoagulation alone (AC) and those receiving advanced reperfusion therapy (ART). Results There were 128 PERT activations over three years, the majority originating from the emergency department. Eighty-five percent of activations were for submassive PE, with 56% of all activations assessed as submassive-high risk. Fifteen patients (12%) presented with massive PE. Advanced reperfusion therapy was used in 29 (23%) patients, of whom 25 (20%) received catheter-directed thrombolysis. There was an increased risk of major bleeding in the ART group compared with in the AC group (odds ratio [ OR], 17.9; 95% confidence interval [CI], 4.1 to 125.0; P < 0.001), but no increased risk of mortality at 30 days (OR, 2.1; 95% CI, 0.4 to 9.1; P = 0.3). The 30-day mortality rate was 7.8%. Conclusion We describe the first Canadian PERT, a multidisciplinary team aimed at providing urgent individualized care for patients with high-risk PE. Further research is necessary to determine whether a PERT improves clinical outcomes.