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A3780 - The Use of a Pulmonary Embolism Response Team (PERT) at University of Virginia Medical Center to Improve Patient Outcomes
Author Block: K. Pal1, J. Solanki2, A. Kadl1, A. D. Mihalek1, S. Mazimba3, J. Kennedy3, Z. Haskal4, J. Angle4, G. Ailawadi5, P. T. Norton6, K. D. Hagspiel6, D. Burt7, A. Sharma3; 1Pulmonary and Critical care, University of Virginia, Charlottesville, VA, United States, 2Medicine, University of Virginia, Charlottesville, VA, United States, 3Cardiovascular Medicine, University of Virginia, Charlottesville, VA, United States, 4Interventional Radiology, University of Virginia, Charlottesville, VA, United States, 5Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, United States, 6Radiology, University of Virginia, Charlottesville, VA, United States, 7Emergency Medicine, University of Virginia, Charlottesville, VA, United States.
Rationale Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States. Due to scarcity of data in managing sub-massive and massive pulmonary embolism, clear guidelines do not exist. Diagnosis and management spans multiple disciplines and requires prompt and definitive management. Recent modalities such as catheter directed thrombolysis (CDT), systemic lysis, or surgical embolectomies have been used in an attempt to reduce mortality and morbidity. Multidisciplinary team based approaches have developed across the country to streamline patient care on a case-by-case basis to guide the management of sub-massive and massive PEs. Aim At the University Of Virginia Medical Center (UVAMC) we developed a PERT, based on previously established models at other institutions, to allow for quick identification of high risk PE patients, offer treatment guidelines, and provide long term care with the goal to improve mortality and morbidity. Methods We developed a protocol for new acute massive or sub-massive PEs. The PERT is activated, and cases are evaluated by the on-call physician via a multidisciplinary conference call and recommendations for further treatment are provided. Results 77 patients have been evaluated through the UVAMC by the PERT, 30-day mortality has been 12.9%, which is lower than the historical mortality at UVAMC of 18.9% that included all PEs. On presentation, sub-massive and massive PEs were seen in 84.4% and 11.6% with a 30-day mortality of 12% and 22% respectively, whereas epidemiological data reports mortality up to 15% and 50% respectively. 35% of our patients underwent therapies beyond anticoagulation which included CDT (n = 18), mechanical thrombectomy (n = 7), surgical embolectomy (n = 1) and extracorporeal membrane oxygenation (n = 1). In the CDT group, pulmonary systolic artery pressure (PASP) showed a 28% reduction on follow up echocardiograms. 60% of eligible patients had close follow up in an outpatient vascular or pulmonary hypertension clinic clinic, within 3 months of diagnosis for follow up of their PE. Conclusion A multidisciplinary team based approach in patients with acute PE at UVAMC shows improved patient outcome compared to historical data. This approach ensured that several patients had close follow up for their PE in an outpatient setting. There was also an improvement in PASP in a subset of patients who underwent CDT which may suggest that long term complications such as chronic thromboembolic pulmonary hypertension could be avoided in select high risk PE patients undergoing CDT.