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Pulmonary Embolism Response Team — a multidisciplinary approach to pulmonary embolism treatment. Polish PERT Initiative Report

Aleksander Araszkiewicz1, Marcin Kurzyna2, Grzegorz Kopeć3, Sylwia Sławek-Szmyt1, Katarzyna Wrona2, Jakub Stępniewski3, Stanisław Jankiewicz1, Arkadiusz Pietrasik4, Michał Machowski5, Szymon Darocha2, Tatiana Mularek-Kubzdela1, Adam Torbicki2, Piotr Pruszczyk5, Marek Roik5
DOI: 10.33963/KP.a2021.0130
·
Pubmed: 34643260
Affiliations
  1. 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
  2. Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Centre Otwock, Medical Centre for Postgraduate Education, Otwock, Poland
  3. Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
  4. Department and Faculty of Cardiology, Medical University of Warsaw, Warszawa, Poland
  5. Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland

open access

Online first
Original article
Published online: 2021-10-08

Abstract

Background: A pulmonary embolism response team (PERT) is a multidisciplinary team established to improve clinical care for patients with pulmonary embolism (PE). However, data regarding detailed institutional experience and clinical outcomes from such teams are sparse.
Aims: We aim to assess the frequency of activations, patients’ characteristics, PE severity, applied treatments, and outcomes of PE patients treated by Polish PERTs.
Methods: The survey registry was conducted between June 2018 and July 2020. All consecutive PERT activations of four institutionalized PERTs in Poland were analyzed. Patients’ characteristics, therapies applied, and in-hospital outcomes were evaluated.
Results: There were 680 unique PERT activations. The majority of activations originated from emergency departments (44.9%), and the remaining originated from internal medicine/cardiology units (31.1%), surgery/orthopedics (9.1 %), oncology (6.3%), intensive care units (6.0%), and others (2.5%). The origin of activation varied significantly between institutions (P <0.01). Most PERT cases were patients with intermediate-high risk PE (42.9%), whereas high-risk PE occurred in 10% of patients. Anticoagulation alone was delivered to 80.3% patients, and 23.3% patients received at least one advanced therapy: catheter directed therapies (11.3%), systemic thrombolysis (5.3%), surgical embolectomy (2.4%), vena cava filter placement (3.7%), and extracorporeal membrane oxygenation (0.6%). In-hospital mortality in the whole study group was 5.1%, with significant differences between institutions (P = 0.01).
Conclusions: The frequency of PE severity, type of delivered catheter-directed treatment, and in-hospital mortality varies between institutions without significant discrepancies in PERT activations. This variation between expert centers highlights the local differences in PERTs’ organizational and operational forms.

Abstract

Background: A pulmonary embolism response team (PERT) is a multidisciplinary team established to improve clinical care for patients with pulmonary embolism (PE). However, data regarding detailed institutional experience and clinical outcomes from such teams are sparse.
Aims: We aim to assess the frequency of activations, patients’ characteristics, PE severity, applied treatments, and outcomes of PE patients treated by Polish PERTs.
Methods: The survey registry was conducted between June 2018 and July 2020. All consecutive PERT activations of four institutionalized PERTs in Poland were analyzed. Patients’ characteristics, therapies applied, and in-hospital outcomes were evaluated.
Results: There were 680 unique PERT activations. The majority of activations originated from emergency departments (44.9%), and the remaining originated from internal medicine/cardiology units (31.1%), surgery/orthopedics (9.1 %), oncology (6.3%), intensive care units (6.0%), and others (2.5%). The origin of activation varied significantly between institutions (P <0.01). Most PERT cases were patients with intermediate-high risk PE (42.9%), whereas high-risk PE occurred in 10% of patients. Anticoagulation alone was delivered to 80.3% patients, and 23.3% patients received at least one advanced therapy: catheter directed therapies (11.3%), systemic thrombolysis (5.3%), surgical embolectomy (2.4%), vena cava filter placement (3.7%), and extracorporeal membrane oxygenation (0.6%). In-hospital mortality in the whole study group was 5.1%, with significant differences between institutions (P = 0.01).
Conclusions: The frequency of PE severity, type of delivered catheter-directed treatment, and in-hospital mortality varies between institutions without significant discrepancies in PERT activations. This variation between expert centers highlights the local differences in PERTs’ organizational and operational forms.

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Keywords

anticoagulation, catheter-directed therapy, pulmonary embolism, pulmonary embolism response team, thrombolysis

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Title

Pulmonary Embolism Response Team — a multidisciplinary approach to pulmonary embolism treatment. Polish PERT Initiative Report

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2021-10-08

DOI

10.33963/KP.a2021.0130

Pubmed

34643260

Keywords

anticoagulation
catheter-directed therapy
pulmonary embolism
pulmonary embolism response team
thrombolysis

Authors

Aleksander Araszkiewicz
Marcin Kurzyna
Grzegorz Kopeć
Sylwia Sławek-Szmyt
Katarzyna Wrona
Jakub Stępniewski
Stanisław Jankiewicz
Arkadiusz Pietrasik
Michał Machowski
Szymon Darocha
Tatiana Mularek-Kubzdela
Adam Torbicki
Piotr Pruszczyk
Marek Roik

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