Outcomes of Patients with Pulmonary Embolism Receiving Ultrasound-Assisted Catheter Directed Thrombolysis After Implementation of a Pulmonary Embolism Response Team in a Community Teaching Hospital

Background
Evidence has shown that risk stratification of patients (pts) with pulmonary embolism (PE) into low-risk, sub-massive (usually defined as PE with RV strain in the absence of shock) and massive PE may result in better outcomes as some pts with sub-massive PE may fare better with more aggressive therapy. Treating pts with ultrasound-assisted catheter directed thrombolysis (EKOS) has been shown to improve clinical parameters with acceptable safety rates. We implemented a PERT at our community hospital and sought to review our experience.

Methods
40 consecutive pts undergoing EKOS at Swedish Covenant Hospital were followed as a prospective cohort for the outcome of death and major bleed. Secondary endpoints included assessment of pre/post pulmonary artery pressure (PAP). Clinical variables were ascertained by database query and endpoints by review of records. Data were analyzed using Excel and the paired-t test.

Results
40 pts (mean age 56.5 years) underwent EKOS for sub-massive PE. Baseline parameters included RV:LV ratio by CTA of 1.2, troponin positive in 61% of pts. 30-day and 1 year mortality was 0%. Major bleeding was seen in 2 pts (one pt needing transfusion for access site hematoma and one elderly pt with small ICH 3 days post-EKOS). Pre/post PAP were 48 mmHg and 39 mmHg respectively; paired p value: 0.014.

Conclusions
Starting a PERT team can be successful in a community hospital setting and EKOS plays an important role. Safety endpoints were acceptable. Future directions include the role of EKOS in reducing length of stay and useage of direct oral anticoagulants. Additional data will be needed to help define optimal treatment for pts with higher-risk PE.