PB0936 - Usefulness of the PERT committee for decision-making in patients with severe pulmonary embolism and intermediate/high and high risk of death.

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

JOSE M. CERESETTO, MD

STAFF
HOSPITAL BRITANICO DE BUENOS AIRES
BUENOS AIRES, Buenos Aires, Argentina

Co-Author(s)

MB

Milagros Báez

CLINICIAN
HOSPITAL BRITANICO DE BUENOS AIRES
BUENOS AIRES, Buenos Aires, Argentina
VG

VICTORIA GUTIERREZ

CLINICIAN
HOSPITAL BRITANICO DE BUENOS AIRES
BUENOS AIRES, Buenos Aires, Argentina
JA

JOSE ALVAREZ

HAEMODINAMICIST
HOSPITAL BRITANICO DE BUENOS AIRES
BUENOS AIRES, Buenos Aires, Argentina
FB

FEDERICO BOTTARO

CLINICIAN
HOSPITAL BRITANICO DE BUENOS AIRES
buenos aires, Buenos Aires, Argentina
PC

PABLO COMIGNIANI

EMERGENTOLOGIST
HOSPITAL BRITANICO DE BUENOS AIRES
BUENOS AIRES, Buenos Aires, Argentina
HA

HORACIO AVACA

CARDIOLOGIST
HOSPITAL BRITANICO DE BUENOS AIRES
BUENOS AIRES, Buenos Aires, Argentina
MB

MARTIN BOSIO

NEUMONOLOGIST
HOSPITAL BRITANICO DE BUENOS AIRES
BUENOS AIRES, Buenos Aires, Argentina

Background: Pulmonary thromboembolism (PE) is a significant cause of death in high-risk and intermediate/high-risk patients (HR/IHR). Multidisciplinary rapid response PE groups (PERT) were created to improve management in these cases. In 2021 a PERT committee began operating in our hospital.

Aims: Recognize clinical characteristics and therapeutic strategies of patients with severe PE and compare the management of PERT with a PRE-PERT historical cohort of patients with the same risk hospitalized in the critical care unit (CCU).

Methods: A comparative observational study of two cohorts with HR/IHR PE, defined as increased cardiac troponins + RV dysfunction/enlargement by echocardiogram, helical CT and PESIs III-IV score with clinical parameters of severity (with or without hemodynamic instability). The PRE-PERT cohort included 33/83 (39%) HR/IHR PE patients at CCU. The PERT cohort 33/150 patients (22%): 25 HR/IHR and 6 intermediate risk that required inferior vena cava filter (IVCF).

Results: In PERT group a significant increase in procedures beyond anticoagulation was observed in HR/IHR patients compared to the historical cohort. Procedures include IVCF (22% PRE-PERT vs 36% PERT p: 0.9); systemic fibrinolytics (24% PRE-PERT vs 36% PERT p: 0.77); or catheter directed thrombolysis (12% PRE-PERT vs 20% PERT p: 0.72). A significantly lower frequency of only anticoagulation was present in PERT cohort (54% PERT vs 20% PRE-PERT p: 0.01). In HR/IHR patient’s PERT team changed behavior with an intervention in 80% (20 of 25) compared to 46% PRE-PERT group (18 of 33). One-month mortality attributed to PE was 4 and 1 in PRE-PERT and PERT group.

Conclusion(s): We compare HR/IHR PE patients that required activation of PERT with a same risk historical cohort in CCU and find a tendency to perform more interventional procedures and lower acute PE mortality after the intervention of PERT. This improvement remains to be confirmed with randomized studies.