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Effect of pulmonary embolism response team on advanced therapies administered: The University of Michigan experience

  • Nelish S. Ardeshna
    Correspondence
    Corresponding author at: 1500 E Medical Center Drive, TC 311Q SPC 5368, Ann Arbor, MI 48109, USA.
    Affiliations
    University of Michigan Department of Internal Medicine, 1500 East Medical Center Drive, 3110 Taubman Center, SPC 5368, Ann Arbor, MI 48109, USA
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  • Melinda Song
    Affiliations
    University of Michigan School of Medicine, 7300 Medical Science Building I — A Wing, 1301 Catherine St., Ann Arbor, MI 48109, USA
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  • Syed N. Hyder
    Affiliations
    University of Michigan Department of Internal Medicine, 1500 East Medical Center Drive, 3110 Taubman Center, SPC 5368, Ann Arbor, MI 48109, USA

    University of Michigan Division of Cardiovascular Medicine, 1500 E. Medical Center Drive, 2139 Cardiovascular Center, Ann Arbor, MI 48109, USA
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  • Kelsey A. Grace
    Affiliations
    University of Michigan Department of Emergency Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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  • Connor O'Hare
    Affiliations
    University of Michigan Department of Emergency Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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  • William J. Schaeffer
    Affiliations
    University of Michigan Department of Emergency Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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  • Michael Stover
    Affiliations
    University of Michigan Department of Emergency Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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  • Colin F. Greineder
    Affiliations
    University of Michigan Department of Emergency Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA

    University of Michigan Department of Pharmacology, 2301 MSRB III, 1150 W. Medical Center Dr., Ann Arbor, MI 48109, USA
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  • Geoffrey D. Barnes
    Affiliations
    University of Michigan Department of Internal Medicine, 1500 East Medical Center Drive, 3110 Taubman Center, SPC 5368, Ann Arbor, MI 48109, USA

    University of Michigan Division of Cardiovascular Medicine, 1500 E. Medical Center Drive, 2139 Cardiovascular Center, Ann Arbor, MI 48109, USA
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Published:November 24, 2022DOI:https://doi.org/10.1016/j.thromres.2022.11.017

      Abstract

      Background

      Pulmonary Embolism Response Teams (PERT) were employed at multiple institutions to bridge the gap between varied treatment options for acute PE and unclear evidence for optimal management. There is limited data regarding the impact of PERT on the use of advanced therapies and clinical outcomes.

      Methods

      We performed a retrospective single-center cohort study comparing patients that presented to the ED with an acute PE before and after the creation of PERT in June 2017 at our institution. We assessed utilization of advanced therapies, LOS, and mortality.

      Results

      A total of 817 patients (168 pre-PERT, 649 post-PERT) were evaluated in the ED with an acute PE between October 2016 and December 2019. Both groups were similar in demographics, comorbidities, and PESI score. There was a decrease in advanced therapy use (16 % vs. 7.5 %, p = 0.006) after PERT creation. Most notable decreases were in catheter-based therapies (8.5 % vs. 2.2 %, p = 0.008) and IVC filter placement (5.3 % vs. 3.2 %, p < 0.001). Median ICU LOS (2.5 days vs. 2.3 days, p = 0.55) and hospital LOS (3.1 vs. 3.0, p = 0.92) did not vary pre-PERT vs. post-PERT. In-hospital mortality (8.5 % vs. 5.0 %, p = 0.29) and 30-day all-cause mortality (1.2 % vs. 0.5 %, p = 0.28) were not different between the two groups as well.

      Conclusion

      At our institution, PERT was associated with a decrease in advanced therapies administered to acute PE patients without affecting mortality or LOS. Additional studies to assess impact of this multi-disciplinary care team model on interventional therapies and clinical outcomes for PE at a broader level are necessary.

      Abbreviations:

      CDT (catheter-directed thrombolysis or thrombectomy), CTPE (pulmonary embolism protocol CT), DVT (deep vein thrombosis), ECMO (extracorporeal membrane oxygenation), ED (Emergency Department), ESC (European Society of Cardiology), LOS (length of stay), PE (pulmonary embolism), PERT (Pulmonary Embolism Response Team), PESI (Pulmonary Embolism Severity Index)

      Keywords

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