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Original Research: Pulmonary Vascular Disease |

A Multidisciplinary Pulmonary Embolism Response Team: Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism

Christopher Kabrhel, MD, MPH; Rachel Rosovsky, MD, MPH; Richard Channick, MD; Michael R. Jaff, DO; Ido Weinberg, MD; Thoralf Sundt, MD; David M. Dudzinski, MD, JD; Josanna Rodriguez-Lopez, MD; Blair A. Parry, CCRC, BA; Savanah Harshbarger, BS; Yuchiao Chang, PhD; Kenneth Rosenfield, MD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aCenter for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

bDivision of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

cDivision of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

dFireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA

eDivision of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

fDivision of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA

gDepartment of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

CORRESPONDENCE TO: Christopher Kabrhel, MD, MPH, Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Pl, Ste 3B, Boston, MA 02114


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):384-393. doi:10.1016/j.chest.2016.03.011
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Background  Integrating newly developed tests and treatments for severe pulmonary embolism (PE) into clinical care requires coordinated multispecialty collaboration. To meet this need, we developed a new paradigm: a multidisciplinary Pulmonary Embolism Response Team (PERT). In this report, we provide the first longitudinal analysis of patients treated by a PERT.

Methods  Our PERT includes specialists in cardiovascular medicine and surgery, emergency medicine, hematology, pulmonary/critical care, and radiology, and is organized as a rapid response team. We prospectively captured clinical, therapeutic, and outcome data at PERT activation and during follow-up periods up to 365 days. We analyzed data collectively, and as five mutually exclusive 6-month periods. We performed Fisher exact tests and regression analysis to test for trend.

Results  In 30 months, there were 394 unique PERT activations, 314 (80%) for confirmed PE. PERT activations increased by 16% every 6 months. Most confirmed PEs were submassive (n = 143, 46%) or massive (n = 80, 26%). The PERT treated a relatively large proportion of patients with PE and systemic or catheter-directed thrombolysis (n = 35, 11%), though the most common treatment was anticoagulation alone (n = 215, 69%). Hemorrhagic complications were rare overall, especially among patients treated with catheter-directed thrombolysis. The all-cause 30-day mortality of PERT patients with confirmed PE was 12%.

Conclusions  We report our initial 30-month experience with a novel multidisciplinary PERT that rapidly engages multiple specialists to deliver efficient, organized, and evidence-based care to patients with high-risk PE. The PERT paradigm was rapidly adopted and may become a new standard of care for patients with PE.

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