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West Coast PERT: A First Year Experience with a Multidisciplinary Pulmonary Embolism Response Team
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A6340 - West Coast PERT: A First Year Experience with a Multidisciplinary Pulmonary Embolism Response Team
Author Block: B. Lindgren, A. Weinberg, O. Friedman, S. Dohad, V. F. Tapson; Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Introduction Acute pulmonary embolism (PE) is frequently misdiagnosed and is associated with morbidity and short- and long-term mortality. As therapeutic options continue to increase, appropriate patient selection is paramount to optimize outcomes. We implemented a PE response team (PERT) at our tertiary care hospital consisting of pulmonary and critical care attendings and fellows, interventional cardiology, interventional radiology, and cardiothoracic surgery. We describe our one-year experience with a PERT.Methods Retrospective chart review of all PERT consults from 7/1/16 to 7/1/17. All patients were included in the review. Clinical parameters, treatment, survival, and discharge anticoagulation were evaluated. Results 102 patients were included. PE was present in 86/102 (84.3%) of consults. Other reasons for consultation included RA/RV clot-in-transit (5%), DVT (4%), abnormal V/Q scan (3%), clot on catheter tip (1%), PE history (1%), and hypoxemia (1%). 74% of the patients had bilateral PE. The average PESI score and BNP were 106.35 + 47.61 and 531.63 + 725.75, respectively. 65/86 (75.5%) of PE patients had a sPESI > 0. The majority of the patients diagnosed with PE were classified as intermediate-risk. There were 43% intermediate-high risk patients and 16% intermediate-low risk. 9% of patients had massive (high-risk) PE and 33% were low-risk PE. Of the 8 patients classified as massive PE, all patients received intravenous (IV) tissue-type plasminogen activator (tPA). Doses of tPA ranged from 47 mg to 100 mg. One patient diagnosed with high intermediate-risk PE progressed to massive PE and received catheter-directed therapy with 15 mg of tPA, and then 50 mg of IV tPA. 15% of patients underwent ultrasound-assisted catheter-directed thrombolysis. Dose and duration of infusion varied depending on several parameters (dose range from 6 to 24 mg with duration 4 to 24 hours). 4% of patients underwent clot extraction without lysis. One patient was placed on veno-arterial extracorporeal membrane oxygenation (ECMO). 17% received a retrievable IVC filter. Survival to hospital discharge was 90.3%. Conclusion Our study describes our 1-year experience with a PERT. The primary reason for consultation was intermediate-risk PE. Survival to hospital discharge was > 90%. We believe that improving risk-stratification, careful assessment of new technology and the utilization of a multidisciplinary PERT can ultimately improve the management of acute PE.
Author Block: B. Lindgren, A. Weinberg, O. Friedman, S. Dohad, V. F. Tapson; Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Introduction Acute pulmonary embolism (PE) is frequently misdiagnosed and is associated with morbidity and short- and long-term mortality. As therapeutic options continue to increase, appropriate patient selection is paramount to optimize outcomes. We implemented a PE response team (PERT) at our tertiary care hospital consisting of pulmonary and critical care attendings and fellows, interventional cardiology, interventional radiology, and cardiothoracic surgery. We describe our one-year experience with a PERT.Methods Retrospective chart review of all PERT consults from 7/1/16 to 7/1/17. All patients were included in the review. Clinical parameters, treatment, survival, and discharge anticoagulation were evaluated. Results 102 patients were included. PE was present in 86/102 (84.3%) of consults. Other reasons for consultation included RA/RV clot-in-transit (5%), DVT (4%), abnormal V/Q scan (3%), clot on catheter tip (1%), PE history (1%), and hypoxemia (1%). 74% of the patients had bilateral PE. The average PESI score and BNP were 106.35 + 47.61 and 531.63 + 725.75, respectively. 65/86 (75.5%) of PE patients had a sPESI > 0. The majority of the patients diagnosed with PE were classified as intermediate-risk. There were 43% intermediate-high risk patients and 16% intermediate-low risk. 9% of patients had massive (high-risk) PE and 33% were low-risk PE. Of the 8 patients classified as massive PE, all patients received intravenous (IV) tissue-type plasminogen activator (tPA). Doses of tPA ranged from 47 mg to 100 mg. One patient diagnosed with high intermediate-risk PE progressed to massive PE and received catheter-directed therapy with 15 mg of tPA, and then 50 mg of IV tPA. 15% of patients underwent ultrasound-assisted catheter-directed thrombolysis. Dose and duration of infusion varied depending on several parameters (dose range from 6 to 24 mg with duration 4 to 24 hours). 4% of patients underwent clot extraction without lysis. One patient was placed on veno-arterial extracorporeal membrane oxygenation (ECMO). 17% received a retrievable IVC filter. Survival to hospital discharge was 90.3%. Conclusion Our study describes our 1-year experience with a PERT. The primary reason for consultation was intermediate-risk PE. Survival to hospital discharge was > 90%. We believe that improving risk-stratification, careful assessment of new technology and the utilization of a multidisciplinary PERT can ultimately improve the management of acute PE.
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