Clinical impact of pulmonary embolism response team consultation at a single tertiary care center

Introduction: Management of pulmonary embolism (PE) is complex, requiring nuanced discussions of diverse treatment modalities. To address this challenge the University of Colorado instituted a Pulmonary Embolism Response Team (PERT), a multidisciplinary team available to risk-stratify and provide management recommendations for patients with PE. Others have examined the impact of the presence of a PERT in pre-post analyses, but fewer studies have studied the effect of PERT consultation on patients with intermediate and high risk PE. We describe demographics, and clinical outcomes among patients that received a PERT consult (PC) or did not (NPC), as well as procedures in the 2 years before and after PERT initiation. Methods: By chart review we retrospectively assessed patients with intermediate or high-risk PE, from 4/1/19 - 4/1/21 for 30-day mortality and hospital length of stay(LOS). We used logistic and linear regression adjusting for age, sex, and common comorbidities including heart failure, cirrhosis, and cancer. We compared the number of procedures performed for PE before and after PERT initiation. Results: 241 patients were included, of which 121 were NPCs. PCs were similar to NPCs in age and sex. PCs were more likely to have thrombophilia and history of venous thromboembolism, and less likely to have cancer (p <.05). 30-day mortality: PCs had an OR of .21 (95%CI 0.07 - 0.54). LOS(days): NPC median 7.5 (3.5 -13.6), PC median 4 (2.5 -7.5). Linear regression: PC LOS were 3.8 days shorter than NPC LOS (95% CI -6.9 - -0.68). There was not a significant difference in the number of procedural interventions between PCs and NPCs. Following PERT initiation, procedural interventions fell by 19%. Catheter lysis (CL) dropped from 66% to 19% of procedures and thrombectomy (TM) increased from 22% to 77% of procedures (p < 0.01). Conclusions: PCs had superior 30-day mortality and lengths of stay when compared to NPCs, suggesting that patients benefit from PERT consultation. However, these results may be confounded by higher rates of cancer among NPCs or other confounders. PERT initiation was associated with fewer procedures and a shift from CL to TM. Further research is being done to evaluate potential barriers to PERT consultation, and the role of the PERT in the management of more medically complex patients.