Five Year Experience of the Gipuzkoa Pulmonary Embolism Response Team (GiTEP) in the Basque Country

Abstract

Background: The GiTEP multidisciplinary response team was created in January 2012 to provide the highest level of care to patients with severe pulmonary embolism in a region of 800,000 inhabitants. The aim of creating the team was to improve coordination between the services involved in the process, delivering a more streamlined, active, complete and personalised response.

Methods: the GiTEP team is made up of specialists from Intensive Care, Interventional Cardiology, Cardiac Surgery, Pneumology, Radiology, Emergency Department, Haematology and Oncology. This paper analyses, in a prospective observational study, the demographic characteristics, treatment and progress of patients admitted between January 2012 and December 2016 over the first six months of treatment. Differences between ratios were analyzed using the χ² method or Fisher’s exact test and regression analysis was used to verify tendencies.

Results: 178 PE patients were admitted to Intensive Care and stratified according to the European Society of Cardiology 2014 classification. The GiTEP protocol was activated in 124 patients (70% ), of which 35 were classified as high risk and 89 as intermediate-high risk. Mean age = 65 years; 50.6% male. The most frequently administered treatment was anticoagulation (57.3% ); the advanced reperfusion therapy of choice was catheter-directed therapy (28.1% ), followed by systemic thrombolysis with rtPA (12.4% ). No surgery was performed. 6.7%of patients experienced haemorrhagic complications, in no case life-threatening or intracranial. The median length of ICU stay was 3 days and of hospital stay was 9 days. The mortality rate at 30 days was 6.2% .

Conclusion: Multidisciplinary intervention in severe pulmonary embolism has resulted in a more proactive, systematic treatment of patients in the region, with no serious haemorrhagic complications and a mortality rate lower than expected.