Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience

Area of Science:

• Cardiology
• Pulmonary Medicine
• Emergency Medicine

Background:

• Clinical equipoise exists regarding novel reperfusion therapies for high-risk pulmonary embolism (PE).
• Treatment decisions for PE are influenced by clinical presentation, patient factors, and institutional resources.
• A Pulmonary Embolism Response Team (PERT) was established to manage high-risk PE patients.

Purpose of the Study:

• To evaluate the outcomes of a multidisciplinary Pulmonary Embolism Response Team (PERT) in managing high-risk PE.
• To assess the utilization of advanced reperfusion therapies (ART) within the PERT framework.
• To compare mortality and bleeding risks between anticoagulation alone (AC) and ART groups.

Main Methods:

• Retrospective data collection from PERT activations between January 2016 and December 2018.
• Chi-square tests and logistic regression analyses were employed.
• Outcomes compared included 30-day and 90-day mortality and major bleeding events.

Main Results:

• 128 PERT activations occurred, primarily for submassive PE (85%).
• Advanced reperfusion therapy (ART) was administered to 23% of patients, with catheter-directed thrombolysis in 20%.
• ART was associated with increased major bleeding risk (OR, 17.9) but not 30-day mortality (OR, 2.1); 30-day mortality was 7.8%.

Conclusions:

• The first Canadian PERT was established to provide urgent, individualized care for high-risk PE patients.
• The study highlights the increased bleeding risk associated with ART in PE management.
• Further research is needed to confirm if PERT implementation improves clinical outcomes.