Impact of a PERT initiative on hospital mortality of patients with bilateral pulmonary embolism. (25th November 2020)

• Record Type: Journal Article
• Authors: Ramos Lopez, N; Luque Diaz, T; Ferrera, C; Enriquez Vazquez, D; Mahia Casado, P; Noriega Sanz, F.J; Manas Hernandez, A; Abelaira Freire, J; Islas Ramirez, F; Perez Serrano, M; Higueras Nafria, J; Galvan Herraez, L; Pedrajas, J; Fernandez Ortiz, A; Salinas Sanguino, P
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Acute Cardiac Care - CCU, Intensive, and Critical Cardiovascular Care; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.1841
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Implication of rapid-response teams have demonstrated significant improvement in several cardiovascular diseases, such as myocardial infarction and stroke. Thus, pulmonary embolism (PE) response teams (PERT) for the management of high-risk PE are encouraged in the guidelines. Purpose: We aimed to assess the impact of a PERT initiative on hospital mortality. PERT was designed to manage patients with bilateral PE with RV/LV ratio >0.9 and positive biomarkers. Methods: We prospectively recruited all consecutive patients with intermediate-high and high-risk bilateral PE who required PERT activation from February-2018 to September-2019 (PERT group, n=56 patients). We compared them with patients with bilateral PE admitted to our hospital in a previous 2-year period (2014–2016), managed with standard of care (SC-group, n=172 patients). As a secondary analysis, we focused on patients with a RV/LV ratio>0.9 (n=52, in the SC-group; n=55, 98% in the PERT-group). Results: Results are shown on Table. The SC-group had a lower risk profile at admission (lower PESI score, heart rate, and higher oxygen saturation), compared to PERT-group. The proportion of patients with RV enlargement on CT (RV/LV >0.9) was lower in the retrospective cohort (p<0.001). Peak Troponin I was significantly higher in the PERT-group (Table). Reperfusion treatment was more frequently needed in PERT patients. On the contrary, there was no difference in the use of vasopressors (5.8% vs 12.5%, p=0.098) and orotracheal intubation (4.1% vs 5.4%, p=0.689) between groups. In-hospital mortality was lower in the PERT-group in the whole cohort (Table) and much lower when considering patients with RV/LV ratio>0.9 (17.6% vs 1.8%, p=0.005). Conclusion: PERT initiative is associated with a significant reduction in mortality compared to the standard of care in patients with bilateral high-risk PE. Funding Acknowledgement: Type of funding source: None