Pulmonary embolism response teams. A description of the first 36-month Australian experience

Bapti Roy; Jin-Gun Cho; Luke Baker; Liza Thomas; Jennifer Curnow; John J Harvey; Paul Geenty; Ashoke Banerjee; Kevin Lai; Mauro Vicaretti; Odette Erksine; Jane Li; Rafid Alasady; Vanessa Wong; Jian E Tai; Caitlin Thirunavukarasu; Imran Haque; Jimmy Chien; Westmead Hospital Pulmonary Embolism Response Team

doi:10.1111/imj.16363

Pulmonary embolism response teams. A description of the first 36-month Australian experience

Intern Med J. 2024 Mar 18. doi: 10.1111/imj.16363. Online ahead of print.

Authors

Bapti Roy^{1

2}, Jin-Gun Cho^{1

3}, Luke Baker⁴, Liza Thomas^{3

5

6}, Jennifer Curnow^{3

7}, John J Harvey⁴, Paul Geenty⁵, Ashoke Banerjee⁸, Kevin Lai⁹, Mauro Vicaretti^{3

10}, Odette Erksine^{1

3}, Jane Li⁴, Rafid Alasady⁴, Vanessa Wong¹, Jian E Tai¹, Caitlin Thirunavukarasu⁷, Imran Haque¹, Jimmy Chien^{1

3}; Westmead Hospital Pulmonary Embolism Response Team

Affiliations

¹ Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
² School of Medical & Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.
³ Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia.
⁵ Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.
⁶ South Western Sydney Clinical School, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia.
⁷ Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia.
⁸ Department of Intensive Care Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
⁹ Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
¹⁰ Department of Vascular Surgery, Westmead Hospital, Sydney, New South Wales, Australia.

PMID: 38497689
DOI: 10.1111/imj.16363

Abstract

Background: High/intermediate-risk pulmonary embolism (PE) confers increased risk of cardiovascular morbidity and mortality. International guidelines recommend the formation of a PE response team (PERT) for PE management because of the complexity of risk stratification and emerging treatment options. However, there are currently no available Australian data regarding outcomes of PE managed through a PERT.

Aims: To analyse the clinical and outcome data of patients from an Australian centre with high/intermediate-risk PE requiring PERT-guided management.

Methods: We performed a retrospective observational study of 75 consecutive patients with high/intermediate-risk PE who had PERT involvement, between August 2018 and July 2021. We recorded clinical and interventional data at the time of PERT and assessed patient outcomes up to 30 days from PERT initiation. We used unpaired t tests to compare right to left ventricular (RV/LV) ratios by computed tomography criteria or transthoracic echocardiogram (TTE) at baseline and after interventions.

Results: Data were available for 74 patients. Initial computed tomography pulmonary angiography RV/LV ratio was increased at 1.65 ± 0.5 and decreased to 1.30 ± 0.29 following PERT-guided interventions (P < 0.001). TTE RV/LV ratio also decreased following PERT-guided management (1.09 ± 0.19 vs 0.93 ± 0.17; P < 0.001). 20% of patients had any bleeding complication, but two-thirds were mild, not requiring intervention. All-cause mortality was 6.8%, and all occurred within the first 7 days of admission.

Conclusion: The PERT model is feasible in a large Australian centre in managing complex and time-critical PE. Our data demonstrate outcomes comparable with existing published international PERT data. However, successful implementation at other Australian institutions may require adequate centre-specific resource availability and the presence of multispeciality input.

Keywords: PERT; anticoagulation; catheter-directed thrombolysis; pulmonary embolism; pulmonary embolism response team.