PB0293 - Development of a Pediatric Pulmonary Embolism Response Team: An Institutional Experience

Background: Pulmonary embolism (PE) has become a more common problem especially during COVID-19. Evidence based management is lacking in pediatrics where anticoagulation, thrombolysis, or interventions are high risk and morbidity and mortality can be significant. There is growing need to establish pediatric PE response teams (P-PERT) to assist clinical teams in the timely management of pediatric PE.

Aims: To create a P-PERT of key stakeholders to improve recognition, hasten intervention and improve outcomes by limiting inconsistencies and delays in care

Methods: In 2019, we created a team of key stake holders including critical care medicine, hematology, emergency medicine, transfusion medicine, ECMO, cardiovascular surgery, and interventional cardiology. A treatment algorithm was created for patients with diagnosed or suspected PE assisting the bedside clinician in identifying high-risk patients requiring expertise of the PERT (massive OR submassive PE). High-risk patients underwent immediate anticoagulation and virtual consultation from the P-PERT within 30 minutes. A patient-specific treatment plan is created, considering patient stability, risks of intervention, risks of anticoagulation or thrombolysis, and need for ECMO. Low risk patients are managed by hematology without P-PERT. To minimize inconsistencies an electronic order set incorporating commonly used vasoactive medications, anticoagulation, imaging, laboratory testing was created to assist in bedside teams

Results: The P-PERT has been called out for 21 patients since its launch in December 2020, all received anticoagulation in the form of heparin infusion +/- bolus of heparin or bivalirudin followed by enoxaparin or rivaroxaban. Six patients with massive PE underwent catheter-based interventions (thrombectomy or thrombolysis) in addition to systemic anticoagulation, while two were placed on ECMO.

Conclusion(s): With the increasing cases of hospital VTEs and PE in pediatric care, establishment of a P-PERT is crucial to rapidly identify those patients needing treatment beyond anticoagulation. We hereby report the first P-PERT at large tertiary pediatric institution