• 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, and Westmead Hospital Pulmonary Embolism Response Team.
• Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
• Intern Med J. 2024 Aug 1; 54 (8): 128312911283-1291.

BackgroundHigh/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.AimsTo analyse the clinical and outcome data of patients from an Australian centre with high/intermediate-risk PE requiring PERT-guided management.MethodsWe 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.ResultsData 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.ConclusionThe 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.© 2024 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

22 keywords...

hide…