Thực hiện đội phản ứng với tắc mạch phổi (PERT) và giá trị lâm sàng của nó ở các quốc gia: một nghiên cứu tổng quát và phân tích tổng hợp

Clinical Research in Cardiology - 2023
Lukas Hobohm1, Ioannis Farmakis2, Karsten Keller1, Barbara Scibior2, Anna C. Mavromanoli2, Ingo Sagoschen1, Thomas Münzel1, Ingo Ahrens3, Stavros Konstantinides2
1Department of Cardiology, Center of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
2Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
3Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Academic Teaching Hospital, University of Cologne, Cologne, Germany

Tóm tắt

Tóm tắt Đặt vấn đề Trong những năm qua, các đội phản ứng tắc mạch phổi đa ngành (PERT) đã xuất hiện để đối phó với sự gia tăng đa dạng và phức tạp trong việc quản lý tắc mạch phổi cấp (PE). Chúng tôi nhằm mục đích điều tra một cách hệ thống thành phần và giá trị lâm sàng bổ sung của PERT. Phương pháp Chúng tôi đã tìm kiếm trên PubMed, CENTRAL và Web of Science đến tháng 1 năm 2022 cho các bài báo mô tả cấu trúc và chức năng của PERT. Chúng tôi đã thực hiện phân tích tổng hợp hiệu ứng ngẫu nhiên của các nghiên cứu có kiểm soát (PERT so với thời kỳ trước PERT) để điều tra tác động của PERT đối với các kết quả lâm sàng và việc sử dụng các liệu pháp nâng cao. Kết quả Chúng tôi đã bao gồm 22 nghiên cứu gốc và bốn cuộc khảo sát. Tổng cộng, 31,5% bệnh nhân mắc PE đã được PERT đánh giá, chủ yếu được giới thiệu từ các khoa cấp cứu (59,4%). Trong 11 nghiên cứu đơn phái (1.532 bệnh nhân có nguy cơ trung bình và cao được đánh giá bởi PERT), tỷ lệ tử vong là 10%, tỷ lệ chảy máu 9% và thời gian nằm viện trung bình là 7,3 ngày [khoảng tin cậy 95% (CI) 5,7–8,9]. Trong chín nghiên cứu có kiểm soát, không có sự khác biệt về tỷ lệ tử vong [tỷ lệ rủi ro (RR) 0,89, CI 95% 0,67–1,19] khi so sánh thời kỳ trước PERT với thời kỳ PERT. Khi phân tích chỉ các bệnh nhân có lớp nguy cơ trung bình hoặc cao, ước lượng tác động cho tỷ lệ tử vong có xu hướng thấp hơn ở những bệnh nhân được điều trị trong thời kỳ PERT so với những người điều trị trong thời kỳ trước PERT (RR 0,71, CI 95% 0,45–1,12). Việc sử dụng các liệu pháp nâng cao cao hơn (RR 2,67, CI 95% 1,29–5,50) và thời gian nằm viện ngắn hơn (chênh lệch trung bình − 1,6 ngày) trong thời kỳ PERT so với thời kỳ trước PERT. Kết luận Việc thực hiện PERT dẫn đến việc sử dụng nhiều hơn các liệu pháp nâng cao và thời gian nằm viện ngắn hơn. Phân tích tổng hợp của chúng tôi không cho thấy lợi ích sống sót ở bệnh nhân mắc PE kể từ khi thực hiện PERT. Cần có các nghiên cứu tiềm năng lớn hơn để khám phá thêm tác động của PERT đối với các kết quả lâm sàng. Đăng ký Khung Khoa học Mở 10.17605/OSF.IO/SBFK9. Tóm tắt đồ họa

Từ khóa


Tài liệu tham khảo

Keller K, Hobohm L, Ebner M, Kresoja KP, Munzel T, Konstantinides SV, Lankeit M (2020) Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany. Eur Heart J 41:522–529

Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jimenez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ni Ainle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL, and Group ESCSD (2020) ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 41:543–603

Hobohm L, Keller K, Munzel T, Gori T, Konstantinides SV (2020) EkoSonic(R) endovascular system and other catheter-directed treatment reperfusion strategies for acute pulmonary embolism: overview of efficacy and safety outcomes. Expert Rev Med Devices 17:739–749

Holmes DR Jr, Rich JB, Zoghbi WA, Mack MJ (2013) The heart team of cardiovascular care. J Am Coll Cardiol 61:903–907

Rosovsky R, Chang Y, Rosenfield K, Channick R, Jaff MR, Weinberg I, Sundt T, Witkin A, Rodriguez-Lopez J, Parry BA, Harshbarger S, Hariharan P, Kabrhel C (2019) Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis. J Thromb Thrombolysis 47:31–40

Dudzinski DM, Piazza G (2016) Multidisciplinary pulmonary embolism response teams. Circulation 133:98–103

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tuncalp O, Straus SE (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169:467–473

Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

Wang X, Ji QW, Rosenfield K, Tapson V, Nie SP (2021) Multidisciplinary pulmonary embolism response team in China: a nationwide survey. Respirology 26:392–393

Todoran TM, Giri J, Barnes GD, Rosovsky RP, Chang YC, Jaff MR, Rosenfield K, Kabrhel C, and Consortium P (2018) Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the pulmonary embolism response team consortium. J Thromb Thrombol 46:39–49

Brailovsky Y, Kunchakarra S, Lakhter V, Barnes G, Masic D, Mancl E, Porcaro K, Bechara CF, Lopez JJ, Simpson K, Mathew V, Fareed J, Darki A (2020) Pulmonary embolism response team implementation improves awareness and education among the house staff and faculty. J Thromb Thrombolysis 49:54–58

Barnes G, Giri J, Courtney DM, Naydenov S, Wood T, Rosovsky R, Rosenfield K, Kabrhel C (1995) Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the National PERT™ Consortium members. Hosp Pract 2017(45):76–80

[Recommendations of the Polish Gynecological Society expert panel on the use of Detramax in pregnancy]. Ginekol Pol 2015;86:962–5. PMID: 26995949

Annabathula R, Dugan A, Bhalla V, Davis GA, Smyth SS, Gupta VA (2021) Value-based assessment of implementing a pulmonary embolism response team (PERT). J Thromb Thrombolysis 51:217–225

Araszkiewicz A, Kurzyna M, Kopec G, Slawek-Szmyt S, Wrona K, Stepniewski J, Jankiewicz S, Pietrasik A, Machowski M, Darocha S, Mularek-Kubzdela T, Torbicki A, Pruszczyk P, Roik M (2021) Pulmonary embolism response team: a multidisciplinary approach to pulmonary embolism treatment. Polish PERT Ini Rep Kardiol Polska 79:1311–1319

Carroll BJ, Beyer SE, Mehegan T, Dicks A, Pribish A, Locke A, Godishala A, Soriano K, Kanduri J, Sack K, Raber I, Wiest C, Balachandran I, Marcus M, Chu L, Hayes MM, Weinstein JL, Bauer KA, Secemsky EA, Pinto DS (2020) Changes in care for acute pulmonary embolism through a multidisciplinary pulmonary embolism response team. Am J Med 133:1313

Chaudhury P, Gadre S, Schneider E, Renapurkar R, Gomes M, Haddadin I, Heresi G, Tong MZY, Bartholomew JR (2019) Impact of multidisciplinary pulmonary embolism response team availability on management and outcomes. Am J Cardiol 124:1465–1469

Deadmon EK, Giordano NJ, Rosenfield K, Rosovsky R, Parry BA, Al-Bawardy RF, Chang YC, Kabrhel C (2017) Comparison of emergency department patients to inpatients receiving a pulmonary embolism response team (PERT) activation. Acad Emerg Med 24:814–821

Finn MT, Gogia S, Ingrassia JJ, Cohen M, Madhavan MV, Nouri SN, Brailovsky Y, Masoumi A, Fried JA, Uriel N, Agerstrand CI, Eisenberger A, Einstein AJ, Brodie D, Rosenzweig EB, Leon MB, Takeda K, Pucillo A, Green P, Kirtane AJ, Parikh SA, Sethi SS (2021) Pulmonary embolism response team utilization during the COVID-19 pandemic. Vasc Med 26:426–433

Groth CM, Acquisto NM, Wright C, Marinescu M, McNitt S, Goldenberg I and Cameron SJ Pharmacists as members of an interdisciplinary pulmonary embolism response team J Am Coll Clin Pharm. PMID: 35813573

Jen WY, Kristanto W, Teo L, Phua J, Yip HS, MacLaren G, Teoh K, Sim TB, Loh J, Ong CC, Chee YL, Kojodjojo P (2020) Assessing the impact of a pulmonary embolism response team and treatment protocol on patients presenting with acute pulmonary embolism. Heart Lung Circul 29:345–353

Kabrhel C, Rosovsky R, Channick R, Jaff MR, Weinberg I, Sundt T, Dudzinski DM, Rodriguez-Lopez J, Parry BA, Harshbarger S, Chang YC, Rosenfield K (2016) 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. Chest 150:384–393

Khaing P, Paruchuri A, Eisenbrey JR, Merli GJ, Gonsalves CF, West FM, Awsare BK (1995) First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation. Hosp Pract 2020(48):23–28

Kwok B, Brosnahan SB, Amoroso NE, Goldenberg RM, Heyman B, Horowitz JM, Jamin C, Sista AK, Smith DE, Yuriditsky E, Maldonado TS (2021) Pulmonary embolism response team activation during the COVID-19 pandemic in a New York city academic hospital: a retrospective cohort analysis. J Thromb Thrombolysis 51:330–338

Melamed R, St Hill CA, Engstrom BI, Tierney DM, Smith CS, Agboto VK, Weise BE, Eckman PM and Skeik N (2020) Effects of a consensus-based pulmonary embolism treatment algorithm and response team on treatment modality choices, outcomes, and complications Clin Appl Thromb-Hemost 26. PMID: 32539524

Mortensen CS, Kramer A, Schultz JG, Giordano N, Zheng H, Andersen A, Nielsen-Kudsk JE and Kabrhel C Predicting factors for pulmonary embolism response team activation in a general pulmonary embolism population J Thromb Thrombolysis. PMID: 34370168

Myc LA, Solanki JN, Barros AJ, Nuradin N, Nevulis MG, Earasi K, Richardson ED, Tsutsui SC, Enfield KB, Teman NR, Haskal ZJ, Mazimba S, Kennedy JLW, Mihalek AD, Sharma AM and Kadl A (2020) Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism Resp Res 21. PMID: 32571318

Parikh M, Chahine NM, Hammad TA, Tefera L, Li J, Carman T, Schilz R, Shishehbor MH (2021) Predictors and potential advantages of PERT and advanced therapy use in acute pulmonary embolism. Catheter Cardiovasc Interv 97:1430–1437

Romano KR, Cory JM, Ronco JJ, Legiehn GM, Bone JN, Finlayson GN (2020) Vancouver general hospital pulmonary embolism response team (VGH PERT): initial three-year experience. Canadian J Anesth-J Canadien D Anesth 67:1806–1813

Rosovsky R, Chang YC, Rosenfield K, Channick R, Jaff MR, Weinberg I, Sundt T, Witkin A, Rodriguez-Lopez J, Parry BA, Harshbarger S, Hariharan P, Kabrhel C (2019) Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis (vol 47, pg 31, 2019). J Thromb Thrombolysis 47:41–41

Sista AK, Friedman OA, Dou E, Denvir B, Askin G, Stern J, Estes J, Salemi A, Winokur RS, Horowitz JM (2018) A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism. Vasc Med 23:65–71

Wiske CP, Shen C, Amoroso N, Brosnahan SB, Goldenberg R, Horowitz J, Jamin C, Sista AK, Smith D, Maldonado TS (2020) Evaluating time to treatment and in-hospital outcomes of pulmonary embolism response teams. J Vasc Surg-Venous Lymph Disord 8:717–724

Wright C, Goldenberg I, Schleede S, McNitt S, Gosev I, Elbadawi A, Pietropaoli A, Barrus B, Chen YL, Mazzillo J, Acquisto NM, Van Galen J, Hamer A, Marinescu M, Delehanty J, Cameron SJ (2021) Effect of a multidisciplinary pulmonary embolism response team on patient mortality. Am J Cardiol 161:102–107

Xenos ES, Davis GA, He Q, Green A, Smyth SS (2019) The implementation of a pulmonary embolism response team in the management of intermediate- or high-risk pulmonary embolism. J Vasc Surg-Ven Lymph Disord 7:493–499

Kendall MR, Swadron S, Clavijo LC, Mehra AK, Hindoyan A, Matthews RV, Shavelle DM (2018) Us of the STEMI team for treatment of patients with pulmonary embolism: a pilot study. J Invas Cardiol 30:367–371

Parikh M, Chahine NM, Hammad TA, Tefera L, Li J, Carman T, Schilz R, Shishehbor MH (2021) Predictors and potential advantages of PERT and advanced therapy use in acute pulmonary embolism. Catheter Cardiovasc Intervent 97:1430–1437

Hobohm L, Sagoschen I, Habertheuer A, Barco S, Valerio L, Wild J, Schmidt FP, Gori T, Munzel T, Konstantinides S and Keller K (2021) Clinical use and outcome of extracorporeal membrane oxygenation in patients with pulmonary embolism Resuscitation. PMID: 34653550

Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM (2013) Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med 158:417–425

Mahar JH, Haddadin I, Sadana D, Gadre A, Evans N, Hornacek D, Mahlay NF, Gomes M, Joseph D, Serhal M, Tong MZ, Bauer SR, Militello M, Silver B, Shishehbor M, Bartholomew JR, Heresi GA (2018) A pulmonary embolism response team (PERT) approach: initial experience from the Cleveland clinic. J Thromb Thrombolysis 46:186–192

Rivera-Lebron B, McDaniel M, Ahrar K, Alrifai A, Dudzinski DM, Fanola C, Blais D, Janicke D, Melamed R, Mohrien K, Rozycki E, Ross CB, Klein AJ, Rali P, Teman NR, Yarboro L, Ichinose E, Sharma AM, Bartos JA, Elder M, Keeling B, Palevsky H, Naydenov S, Sen P, Amoroso N, Rodriguez-Lopez JM, Davis GA, Rosovsky R, Rosenfield K, Kabrhel C, Horowitz J, Giri JS, Tapson V, Channick R, and Consortium P (2019) Diagnosis, treatment and follow up of acute pulmonary embolism: consensus practice from the PERT Consortium. Clin Appl Thromb Hemost 25:1076029619853037

Schultz J, Giordano N, Zheng H, Parry BA, Barnes GD, Heresi GA, Jaber W, Wood T, Todoran T, Courtney DM, Naydenov S, Khandhar S, Green P and Kabrhel C (2019) EXPRESS: a multidisciplinary pulmonary embolism response team (PERT): experience from a national multicenter consortium Pulm Circ 2045894018824563. PMID: 30632901

Barnes G, Giri J, Courtney DM, Naydenov S, Wood T, Rosovsky R, Rosenfield K, Kabrhel C, National PCRC (1995) Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the national PERT consortium members. Hosp Pract 2017(45):76–80

Brailovsky Y, Lakhter V (2021) pulmonary embolism response team: additional call burden or a valuable learning opportunity? J Am Coll Cardiol 77:1691–1696

Lacey MJ, Hammad TA, Parikh M, Tefera L, Sharma P, Kahl R, Zemko A, Li J, Carman T, Schilz R, Shishehbor MH (2021) Prospective experience of pulmonary embolism management and outcomes. J Invasive Cardiol 33:E173–E180

Sullivan AE, Holder T, Truong T, Green CL, Sofela O, Dahhan T, Granger CB, Jones WS and Patel MR (2020) Use of hospital resources in the care of patients with intermediate risk pulmonary embolism Eur Heart J Acute Cardiovasc Care. PMID: 33609111

Hobohm L, Schmidt FP, Gori T, Schmidtmann I, Barco S, Munzel T, Lankeit M, Konstantinides SV, Keller K (2021) In-hospital outcomes of catheter-directed thrombolysis in patients with pulmonary embolism. Eur Heart J Acute Cardiovasc Care 10:258–264

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