Pulmonary Embolism Response Teams

被引:19
作者
Reza N. [1 ]
Dudzinski D.M. [1 ,2 ]
机构
[1] Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray 7-730, Boston, 02114, MA
[2] Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5, Boston, 02114, MA
关键词
Heart team; Massive PE; Multidisciplinary; Pulmonary embolism; Pulmonary embolism response team; Rapid response teams;
D O I
10.1007/s11936-015-0387-9
中图分类号
学科分类号
摘要
Pulmonary embolism (PE) is a complex and multidimensional pathophysiology, the diagnosis and management of which spans multiple disciplines. The high morbidity and associated mortality of “massive” and “submassive” acute PE may require prompt, definitive management; however, current consensus guidelines in this domain are not supported by high-level evidence. Randomized clinical trials comparing available pharmacologic and invasive treatment modalities—including anticoagulation, thrombolysis, and embolectomy—have not been conducted and continue to be challenging to conceptualize, design, and execute. Consequently, time-sensitive therapeutic determinations are largely not standardized, and rendered on a case-by-case basis in part depending on institutional practices and expertises. Chronic sequelae of PE, such as chronic thromboembolic pulmonary hypertension and right heart failure, are increasingly identified as conditions necessitating longitudinal specialty care. These and other challenges have created a niche for a multidisciplinary team which can respond rapidly to unstable patient scenarios, appropriately deploy resources, and offer highly specialized acute and chronic management of PE. The Massachusetts General Hospital Pulmonary Embolism Response Team (PERT), modeled after existing rapid response and collaborative care teams, is a novel approach that combines this clinical service with the development of an educational and research framework to advance the care of patients with PE. © 2015, Springer Science+Business Media New York.
引用
收藏
页数:9
相关论文
共 31 条
[1]  
Stein P.D., Matta F., Epidemiology and incidence: the scope of the problem and risk factors for development of venous thromboembolism, Crit Care Clin, 27, pp. 907-932, (2011)
[2]  
Go A.S., Mozaffarian D., Roger V.L., Et al., American heart association statistics committee and stroke statistics subcommittee. Heart disease and stroke statistics – 2013 update: a report from the American heart association, Circulation, 127, 1, pp. 6-245, (2013)
[3]  
Barritt D.W., Jordan S.C., Anticoagulant drugs in the treatment of pulmonary embolism: a controlled trial, Lancet, 1, pp. 1309-1312, (1960)
[4]  
Carson J.L., Kelley M.A., Duff A., Et al., The clinical course of pulmonary embolism, N Engl J Med, 326, 19, pp. 1240-1245, (1992)
[5]  
Meyer B., Vicaut E., Danays T., Et al., Fibrinolysis for patients with intermediate-risk pulmonary embolism, N Engl J Med, 370, pp. 1402-1411, (2014)
[6]  
Douma R.A., Kamphuisen P.W., Buller H.R., Acute pulmonary embolism. Part 1: epidemiology and diagnosis, Nat Rev Cardiol, 7, pp. 585-596, (2010)
[7]  
LaMori J.C., Shoheiber O., Mody S.H., Bookhart B.K., Inpatient resource Use and cost burden of deep vein thrombosis and pulmonary embolism in the United States, Clin Ther, 37, pp. 62-70, (2015)
[8]  
Weiner R.S., Ouellette D.R., Diamond E., An official American Thoracic Society/American College of Chest Physicians policy statement: the Choosing Wisely top five list in adult pulmonary medicine, 145, 6, pp. 1383-1391, (2014)
[9]  
Venkatesh A.K., Kline J.A., Courtney D.M., Et al., Evaluation of pulmonary embolism in the emergency department and consistency with a national quality measure: quantifying the opportunity for improvement, Arch Intern Med, 172, 13, pp. 1028-1032, (2012)
[10]  
Jaff M.R., McMurtry S., Archer S.L., American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, American Heart Association Council on Peripheral Vascular Disease, American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep venous thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association,