Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis

Hobohm, Lukas, Farmakis, Ioannis T., Keller, Karsten, Scibior, Barbara, Mavromanoli, Anna C., Sagoschen, Ingo, Muenzel, Thomas, Ahrens, Ingo and Konstantinides, Stavros . Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis. Clin. Res. Cardiol.. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1861-0692

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DOI:10.1007/s00392-022-02077-0

Abstract

Background Over the last years, multidisciplinary pulmonary embolism response teams (PERTs) have emerged to encounter the increasing variety and complexity in the management of acute pulmonary embolism (PE). We aimed to systematically investigate the composition and added clinical value of PERTs. Methods We searched PubMed, CENTRAL and Web of Science until January 2022 for articles designed to describe the structure and function of PERTs. We performed a random-effects meta-analysis of controlled studies (PERT vs. pre-PERT era) to investigate the impact of PERTs on clinical outcomes and advanced therapies use. Results We included 22 original studies and four surveys. Overall, 31.5% of patients with PE were evaluated by PERT referred mostly by emergency departments (59.4%). In 11 single-arm studies (1532 intermediate-risk and high-risk patients evaluated by PERT) mortality rate was 10%, bleeding rate 9% and length of stay 7.3 days [95% confidence interval (CI) 5.7-8.9]. In nine controlled studies there was no difference in mortality [risk ratio (RR) 0.89, 95% CI 0.67-1.19] by comparing pre-PERT with PERT era. When analysing patients with intermediate or high-risk class only, the effect estimate for mortality tended to be lower for patients treated in the PERT era compared to those treated in the pre-PERT era (RR 0.71, 95% CI 0.45-1.12). The use of advanced therapies was higher (RR 2.67, 95% CI 1.29-5.50) and the in-hospital stay shorter (mean difference - 1.6 days) in PERT era compared to pre-PERT era. Conclusions PERT implementation led to greater use of advanced therapies and shorter in-hospital stay. Our meta-analysis did not show a survival benefit in patients with PE since PERT implementation. Large prospective studies are needed to further explore the impact of PERTs on clinical outcomes. Registration Open Science Framework 10.17605/OSF.IO/SBFK9. [GRAPHICS] .

Item Type:

Journal Article

Creators:

Creators	Email	ORCID	ORCID Put Code
Hobohm, Lukas	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Farmakis, Ioannis T.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Keller, Karsten	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Scibior, Barbara	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Mavromanoli, Anna C.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Sagoschen, Ingo	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Muenzel, Thomas	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Ahrens, Ingo	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Konstantinides, Stavros	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED