Introduction: Pulmonary embolism response team (PERT) is a multidisciplinary unit designed to deliver rapid, evidence-based and individualized care to critically ill patients with acute pulmonary embolism (PE). Despite the increasing emergence of PERTs, their impact on patient outcomes like mortality have not been studied. We studied the impact of PERT at Cleveland Clinic (CCF) since its launch in July 2014.
Methods: In a retrospective review of our health records, we identified all patients diagnosed with PE on a contrast CT scan one year before and after institution of PERT (Pre-PERT: Jul 2013-Jun 2014, PERT: Jan-Dec 2015). Data from July to Dec 2014 was excluded allowing for dissemination of information regarding PERT availability. Charts were reviewed to obtain demographics, serology, simplified PE severity index (sPESI) variables and echocardiogram results. Patients with normal cardiac markers, no RV dysfunction and sPESI of 0 or 1 were classified as low risk and excluded.
Results: We identified 158, 172 and 38 patients in the Pre-PERT, PERT era without activation (PERT-) and PERT era with activation (PERT+) groups respectively. Of note, since 42% (28/66) of all CCF-PERT activations in the study-period were PEs diagnosed on non-CCF studies/non-CT modalities, these patients did not get included in any group. When comparing PERT+ with Pre-PERT or PERT- patients, no significant differences were noted in average age (55.8yr v 59.9yr or 60.6yr, p=0.3 or 0.5), gender (males 57.9% v 50% or 58.7%, p=0.4 or 0.9) or sPESI (2.3 in all groups, p=0.7 or 0.3). There was a significant difference in 30-day/inpatient mortality between PERT+ and Pre-PERT groups (0% v 11.4%, p=0.02). Mortality difference approached statistical significance when comparing PERT+ and PERT- groups (0% v 8.1%, p=0.06). Finally, there was a trend towards significance when comparing Pre-PERT and all PERT era patients irrespective of PERT activation (11.4% v 6.7%, p=0.1).
Conclusions: Our study revealed that patients who had involvement of PERT in the management of intermediate or high risk PE had lower mortality. Although not statistically significant given the small sample size, this data suggests that availability PERT may impart a survival benefit for all patients with intermediate or high risk PE.