Author + information
- Michael R. Kendall,
- Stuart Swadron,
- Leonardo Clavijo,
- Anilkumar Mehra,
- Antreas Hindoyan,
- Ray V. Matthews and
- David M. Shavelle
Patients with massive and submassive pulmonary embolism (PE) require rapid identification, triage and consideration for reperfusion therapy. The purpose of this analysis was to evaluate a pilot study using the ST elevation myocardial infarction (STEMI) team and a dedicated PE protocol for treatment of patients with massive and submassive PE.
From June 2014 and April 2016, 37 patients with massive and submassive PE were evaluated. Baseline demographics, mode of hospital entry, treatment time intervals (door to computed tomographic pulmonary angiography [CTPA], CTPA to invasive pulmonary angiogram, door to treatment time), procedures performed and in-hospital clinical events were collected.
Mean age was 56 ±14 years, 17 (46%) were male and 10 (27%) had a prior history of deep venous thrombus or PE. Twenty-one patients (57%) had massive PE and 16 patients (43%) had submassive PE. Mode of hospital entry was emergency department (ED) 43%, transfer-in 38% and inpatient 19%. Four patients (11%) presented with cardiac arrest and 8 patients (22%) required intubation. Six patients (16%) did not receive endovascular treatment because of contra indications and/or patient refusal. For patients arriving via the ED, treatment times are shown in the Figure. The most common endovascular treatment was Rheolytic Thrombectomy (RT) alone (16%) and RT with/without other devices combined with thrombolytic infusion (19%). Length of hospital stay was 15±15 days and in-hospital mortality was 11%.
Use of an existing ST elevation myocardial infarction team and activation protocol is an effective means to care for patients with massive and submassive pulmonary embolism. This pilot study achieved rapid treatment times with low in-hospital mortality rates.