PB0927 - Single-centre 10-year experience of a Pulmonary Embolism Response Team (PERT)

Background: Pulmonary embolism (PE) can be associated with significant mortality risk, and in addition to standard treatment with anticoagulation, management options have expanded to include catheter-directed (CD) therapies but their role has yet to be established. Pulmonary embolism response teams (PERT) aim to streamline the clinical management and attempt to improve outcome in those with PE.

Aims: Review the characteristics, treatment and outcomes of patients with intermediate or high-risk PE at our institution following implementation of a PERT in 2014

Methods: Retrospective cohort study from January 2014-December 2023.

Results: Baseline characteristics of 214 patients referred during the study period are in Table 1. There was a large increase in the numbers of patients referred in the study period (Figure 1). Initial PESI classification of PE was very high in 44 (20.6%), high in 34 (15.9%), intermediate in 43 (20.1%), and low in 43 (20.1%) (data not available in 50). The initial troponin 74ng/L (IQR 33, 175.5; normal < 16), and initial NT-proBNP 2405ng/L (IQR 663, 4395.8 ; normal < 400 ). Overall, 125 (58%) patients had additional treatment, including catheter -directed thrombolysis (CDT) in 68 (31.7%), catheter-directed thrombo-aspiration in 19 (8.9%), systemic thrombolysis in 32 (15.0%), surgical embolectomy in 3 (1.4%), and 3 patients had both CDT and thrombo-aspiration. Overall length of stay (LOS) was similar between patients who received catheter-directed therapy (median 10.2 days, IQR 5.4, 18.4) versus those that received no intervention (10.6 days, IQR 4, 20.9). 38 (17.8%) had bleeding of which 8 were major bleeds. Nine (4.2%) patients died from the PE; there were subsequently 17 patients died from underlying disease. Five (2.3%) developed chronic thrombo-embolic pulmonary hypertension (CTEPH).

Conclusion(s): PERTs are valuable for providing multidisciplinary input in managing high-risk and complex PE cases. In time we hope to show improved outcomes in terms of LOS and CTEPH.