OBJECTIVES: To evaluate the effect of implementation of a multidisciplinary pulmonary embolism response team (PERT) for the treatment of patients with submassive (Sm) and massive (M) pulmonary embolism (PE). METHODS: We retrospectively reviewed all patients undergoing treatment for PE at our institution between 1/2020 and 7/2023. SmPE was defined as right ventricle (RV) to left ventricle (LV) ratio greater than 1.0 on echocardiogram along with RV dilation and strain, EKG changes, elevated Troponin and basic natriuretic peptide. MPE was defined as systemic hypotension requiring vasopressors or cardiac arrest. We analyzed presenting symptoms, type of treatment (medical, endovascular, surgical), mortality, morbidity including bleeding complications, ICU and Hospital length of stay (LOS), and reduction in RV:LV ratio. RESULTS: A total of 609 patients were treated for PE between 1/2020 and 7/2023 with 526 (86%) being non-massive PE (Group A) and 123 patients being stratified as Sm (108) or M (15) PE (Group B). Concomitant Deep vein thrombosis was identified in 26% of Group A and 64% of Group B . Dyspnea as presenting symptom was equal in both groups (71%). 100% of Group A underwent anticoagulation alone and 0% underwent endovascular or surgical treatment while 100% of Group B underwent endovascular treatment (78% thrombolysis, 22% mechanical thrombectomy) per established PERT protocol. Elevated biomarkers and EKG changes were present in and 89% Group B. 30-day mortality was 0% in Group A and 2% in Group B and 12 month survival was 92% Group B. ICU LOS (1 days vs 2.5 days) and Hospital LOS ( 4 Days vs 7 Days) were less for Group B. Average reduction in RV:LV ratio immediately following intervention in Group B was 30%. There was 1 % major bleeding complication, 0% myocardial infarction or cardiac complications in Group B
CONCLUSIONS: In our institution, PERT implementation led to greater use of advanced therapies, shorter ICU and hospital LOS for submassive and massive PE than medical treatment alone for non-massive PE. Intervention for submassive and massive PE resulted in low 30-day and 12-month mortality, significant immediate reduction in RV:LV ratio, and low complications rates
