A Multidisciplinary Pulmonary Embolism Response Team: Our Initial 12-month Experience

Background
Management of patients presenting with sub-massive or massive acute pulmonary embolism (PE) may be challenging. A pulmonary embolism response team (PERT) was constructed to establish a standardized treatment pathway for multidisciplinary evaluation and treatment for acute PE at Lahey Hospital and Medical Center.

Methods
We conducted a retrospective chart review on all patients admitted to our center who required activation of PERT during the first year of the program (October 2017 to October 2018). We extracted data pertaining to clinical presentation, imaging and echocardiographic findings, treatment modality, in-hospital and post- discharge follow-up plans. Descriptive and continuous variables were collected and analyzed. Patients were classified as low risk, sub-massive or massive PE.

Results
Sixty-seven patients were evaluated by the PERT. Complete data were available in 65 patients: 34 (52%) were males and 31 (48%) were females. Mean age was 65.6. Right heart strain was confirmed by echocardiogram in 54 (83%) patients. One patient was classified as low-risk PE. Fifty (76%) were classified as sub-massive PE, and 14 (21%) as massive PE. Thirty six (55%) patients received anticoagulation alone, 20 (31%) received catheter directed thrombolysis (CDT), and 9 (14%) received full dose rtPA (only used in massive PE). Four patients required ECMO. Mortality was higher in massive (46%) vs. sub-massive (0.02%) PE. Three patients had bleeding events (2 post TPA, 1 with heparin alone). Right ventricular function was normalized in 92% of patients on repeat echocardiograms within 1-3 months.

Conclusions
The establishment of a PERT team at our center led to a more standardized approach that engages multiple specialists to deliver rapid, organized, and evidence based care to patients with high-risk PE. Our data suggest that massive PE still has a high mortality rate despite receiving prompt TPA. Additionally, CDT can offer a safe and effective treatment of RV strain with low complication and mortality rates. Longer term study is required to determine whether CDT has any important effect on long-term morbidity and mortality.