A56-25 Impact of Pulmonary Embolism Response Team (pert) Implementation in Patients With High Risk Pulmonary Embolism Requiring Mechanical Circulatory Support

Rationale High risk pulmonary emboli (PE) are associated with a high mortality rate (30%). To standardize the response to acute PEs, many hospitals in the United States have implemented PERT. In this report, we analyzed data comparing survival to discharge among patients with high risk PE requiring extracorporeal membrane oxygenation (ECMO) support pre PERT implementation and post PERT implementation at Banner University Medical Center-Phoenix (BUMC-P). Methods This observational, retrospective study analyzed data comparing patients with PE requiring ECMO support pre versus post PERT implementation. The PERT team was introduced at BUMC-P on 08/01/2022. Five patients between 08/01/2020 - 07/31/2022 were analyzed. Six patients were analyzed between 8/01/2022 - 7/31/2024. Inclusion criteria for both the pre versus post groups included use of veno-arterial (VA) ECMO for mechanical circulatory support in patients with PE. The primary end points were survival to ECMO decannulation and survival to discharge. Results Pre PERT team initiation, only 3 out of 5 patients (60%) survived to ECMO decannulation with only 2 of the 5 (40%) surviving to discharge. Post PERT initiation, 4 out of 6 (66.7%) patients survived to ECMO decannulation and 3 out of 6 (50%) patients survived to discharge. Of the pre PERT cohort, 4 patients received pulmonary thrombectomy and only 2 of those 4 patients (50%) survived to discharge. Of the post PERT cohort, 1 patient received catheter directed thrombolysis and survived to discharge. 3 patients received thrombectomies with all 3 patients surviving to decannulation and only 2 of the 3 surviving to discharge. Conclusions Per ELSO registry data, of 97,626 adult patients who received VA ECMO, 45% survived to discharge. Our pre PERT survival to discharge was 40% which improved to 50% post PERT implementation. This is higher than the noted ELSO registry data. If we compare patients in this study who received advanced therapies such as catheter directed thrombolysis or thrombectomy, the survival to discharge increased from 50% pre PERT to 75% post PERT. Although the number of patients analyzed in this study were significantly lower compared to the ELSO registry, it is clear that PERT implementation improved mortality of patients in our hospital for patients with PE requiring ECMO support. Further studies are warranted to analyze overall survival of these patients in the setting of differing variables that come with such acutely ill patients. This study could serve as a framework to allow for a larger study in the future.