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Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis
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. M...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9383680/ https://www.ncbi.nlm.nih.gov/pubmed/35976429 http://dx.doi.org/10.1007/s00392-022-02077-0 |
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author | Hobohm, Lukas Farmakis, Ioannis T. Keller, Karsten Scibior, Barbara Mavromanoli, Anna C. Sagoschen, Ingo Münzel, Thomas Ahrens, Ingo Konstantinides, Stavros |
author_facet | Hobohm, Lukas Farmakis, Ioannis T. Keller, Karsten Scibior, Barbara Mavromanoli, Anna C. Sagoschen, Ingo Münzel, Thomas Ahrens, Ingo Konstantinides, Stavros |
author_sort | Hobohm, Lukas |
collection | PubMed |
description | 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. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00392-022-02077-0. |
format | Online Article Text |
id | pubmed-9383680 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-93836802022-08-17 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 Münzel, Thomas Ahrens, Ingo Konstantinides, Stavros Clin Res Cardiol Original Paper 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. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00392-022-02077-0. Springer Berlin Heidelberg 2022-08-17 2023 /pmc/articles/PMC9383680/ /pubmed/35976429 http://dx.doi.org/10.1007/s00392-022-02077-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Paper Hobohm, Lukas Farmakis, Ioannis T. Keller, Karsten Scibior, Barbara Mavromanoli, Anna C. Sagoschen, Ingo Münzel, Thomas Ahrens, Ingo Konstantinides, Stavros Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis |
title | Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis |
title_full | Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis |
title_fullStr | Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis |
title_full_unstemmed | Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis |
title_short | Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis |
title_sort | pulmonary embolism response team (pert) implementation and its clinical value across countries: a scoping review and meta-analysis |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9383680/ https://www.ncbi.nlm.nih.gov/pubmed/35976429 http://dx.doi.org/10.1007/s00392-022-02077-0 |
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