Impact of Time to Intervention on Catheter-Directed Therapy for Pulmonary Embolism. (17th January 2023)

• Record Type: Journal Article
• Authors: Lehr, Andrew; Guichet, Phillip; Garimella, Bhaskara; Krolikowski, Kelsey; Amoroso, Nancy; Sista, Akhilesh; Brosnahan, Shari B.
• Is Part Of: Critical care explorations. Volume 5:Number 1(2023)
• Page Start: e0828
• Publication Date: 2023-01-17
• Subjects: endovascular procedures -- fibrinolytic agents -- mechanical thrombectomy -- pulmonary embolism -- venous thromboembolism
• DOI: 10.1097/CCE.0000000000000828
• Languages: English
• ISSNs: 2639-8028

Abstract

Abstract : OBJECTIVES: Cather-directed therapies (CDTs) are an evolving therapeutic option for patients with intermediate-risk pulmonary embolism (PE). Although many techniques have been studied, there is limited evidence for the impact of timing of intervention on patient outcomes. Our objective was to assess the association between time to CDT in patients presenting with PE on patient-related outcomes such as length of stay (LOS) and mortality. DESIGN: Retrospective cohort study. SETTING: Single academic center. PATIENTS: We identified patients for which the PE response team had been activated from January 2014 to October 2021. Patients were split into two cohorts depending on whether they went to CDT less than 24 hours from admission (early) versus greater than 24 hours (late). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data on demographics, timing of interventions, pulmonary hemodynamics, and outcomes were collected. Sixty-four patients were included in analysis. Thirty-nine (63.8%) underwent their procedure less than 24 hours from admission, whereas 25 (36.2%) underwent the procedure after 24 hours. The time from admission to CDT was 15.9 hours (9.1–20.3 hr) in the early group versus 33.4 (27.9–41) in the late group ( p ≤ 0.001). There was a greater decrease in pulmonary artery systolic pressure after intervention in the early cohort (14 mm Hg [6–20 mm Hg] vs 6 mm Hg [1–10 mm Hg]; p = 0.022). Patients who received earlier intervention were found to have shorter hospital LOS (4 vs 7 d; p = 0.038) and ICU LOS (3 vs 5 d; p = 0.004). There was no difference in inhospital mortality between the groups (17.9% vs 12%; p = 0.523). CONCLUSIONS: Patients who underwent CDT within 24 hours of admission were more likely to have shorter hospital and ICU LOS. The magnitude of change in LOS between the two cohorts was not fully explained by the difference in time to CDT. There were modest improvements in pulmonary hemodynamics in the patients who underwent CDT earlier.