Role of a multidisciplinary pulmonary embolism response team and impact of interventional therapy in the management of patients with intermediate-high risk pulmonary embolism

Publication Title

9th Annual Pulmonary Embolism Symposium

Authors

Juan N Pulido, Cardiovascular Intensive Care Unit, Department of Cardiothoracic Anesthesiology and Critical Care Medicine, Swedish Heart and Vascular Institute, Swedish Medical Center, US Anesthesia Partners Washington, Seattle, Wash.Follow
Robert Fletcher, Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA
Michelle A. Poitevin, Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WAFollow
Kristina Pratt, Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WAFollow
Paul P Huang, Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WAFollow
Eric J Lehr, Swedish Heart and Vascular Institute, Seattle, WA USA.Follow
George P Pappas, Division of Pulmonology and Critical Care Medicine, Swedish Medical Center, Seattle, WAFollow

Document Type

Abstract

Publication Date

9-21-2023

Keywords

pulmonary embolism; intermediate-high risk; swedish; swedish heart; washington

Abstract

Background: Despite emerging interventional options for pulmonary embolism (PE), the mortality rate for intermediate high-risk PE (IHR-PE) remains high and the optimal therapeutic approach unclear due to a lack of robust outcomes data. We describe the outcomes of patients presenting with IHR-PE managed by a multidisciplinary PERT program with all available reperfusion options.

Methods: This single center retrospective study included EMR data from patients that were a part of the multidisciplinary PERT program from January 2012 to June 2023. PERT was activated if risk of death was intermediate or higher. The simplified pulmonary embolism severity index (sPESI) and Bova score were used as risk stratification tools. Patients with IHR-PE defined as sPESI > 1, and Bova 5 were analyzed according to therapeutic approach yielding 5 groups: anticoagulation alone (AC), systemic thrombolysis (ST), catheter directed thrombolysis (CDT), percutaneous catheter thrombectomy (PCT) and surgical embolectomy (SE). Patient demographics, ICU length of stay, hospital length of stay, hospital mortality, 30-day mortality, AKI, hemorrhagic CNS events were analyzed. The percentages, median and IQR were reported.

Results: Of the 566 patients with PERT activation during the study timeframe, 112 (20%) were classified as intermediate-high risk (BOVA 5) category. Hospital mortality rate was 3.6%. All patients that underwent SE and PCT were alive at 30 days, while mortality in AC, ST and CDT groups was 3.9, 4.3, and 7.1% respectively. Patients undergoing PCT had the shortest ICU and hospital length of stay with 0.7 days (0.2-1.2) and 2.8 days (2-6.2). Patients that received ST and CDT had more days in the ICU (1.7; 1.5), hospital length of stay (5.7;4.6 days) and had higher mortality (3.6; 8.3%).

Conclusion: The coordination of care and management of intermediate-high PE using a multidisciplinary PERT program may improve survival. The emerging role of PCT appears promising by reduction of ICU and hospital length of stay, and mortality. A PERT program with an engaged surgical team supporting is essential for timely rescue of treatment failure or patient decompensation.

Keywords: pulmonary embolism, intermediate-high risk, therapeutic approach.

Disclosures: None

Area of Special Interest

Cardiovascular (Heart)

Specialty/Research Institute

Critical Care Medicine

Specialty/Research Institute

Cardiology

Specialty/Research Institute

Pulmonary Medicine