Pulmonary embolism response team: A multidisciplinary approach to pulmonary embolism treatment. Polish PERT Initiative Report

Abstract

Background: A pulmonary embolism response team (PERT) is a multidisciplinary team established to improve clinical care for patients with pulmonary embolism (PE). However, data regarding detailed institutional experience and clinical outcomes from such teams are sparse. Aims:We aim to assess the frequency of activations, patients' characteristics, PE severity, applied treatments, and outcomes of PE patients treated by Polish PERTs. Methods:The survey registry was conducted between June 2018 and July 2020. All consecutive PERT activations of four institutionalized PERTs in Poland were analyzed. Patients' characteristics, therapies applied, and in-hospital outcomes were evaluated.Results: There were 680 unique PERT activations. Most activations originated from Emergency Departments (44.9%), and the remaining originated from internal medicine/cardiology units (31.1%), surgery/orthopedics (9.1 %), oncology (6.3%), intensive care units (6.0%), and others (2.5%). The origin of activation varied significantly among institutions (P <0.01). Most PERT cases were patients with intermediate-high risk PE (42.9%), whereas high-risk PE occurred in 10% of patients. Anticoagulation alone was delivered to 80.3% of patients, and 23.3% of patients received at least one advanced therapy: catheter-directed therapies (11.3%), systemic thrombolysis (5.3%), surgical embolectomy (2.4%), vena cava filter placement (3.7%), and extracorporeal membrane oxygenation (0.6%). In-hospital mortality in the whole study group was 5.1%, with significant differences between institutions (P = 0.01). Conclusions:The frequency of PE severity, type of delivered catheter-directed treatment, and in-hospital mortality vary between institutions without significant discrepancies in PERT activations. This variation between expert centers highlights the local differences in PERTs' organizational and operational forms.

Pulmonary embolism response teams: A concept in progress and beyond borders

“…Araszkiewicz et al [7] report the use of systemic anticoagulation alone in 80% of PERT activations, higher rates than prior retrospective reports [5,11], but consistent with the notion that most acute PE patients cared for by PERT teams do well with anticoagulation alone. While the implementation of PERT teams is associated with an increased use of advanced PE therapies, these invasive and riskier strategies should not be used liberally, and are best utilized in experienced operators' hands, depending on the local resources and expertise, and in the context of an individualized treatment plan.…”

“…In this context, the study by Araszkiewicz et al [7] in the current issue of Kardiologia Polska (Kardiol Pol, Polish Heart Journal) represents a welcomed addition to the PERT literature. The authors present the polish PERT initiative, by describing the first national, multicenter analysis of patients cared for by four PERTs between 2018 and 2020.…”

Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis

“…The results of the present analysis indicate that the implementation of PERTs is a concept still predominantly implemented in the US. Even though the concept of PERT teams has been endorsed by the 2019 ESC Guidelines, only one study originated in Europe, notably in Poland, and reported on the composition and function of PERTs [ 15 ]. The rationale behind the implementation and structure of PERTs is based on the “heart team” concept, which facilitates patient management with a consensus opinion of different specialists and leads to improved organisation of teams and utilisation of resources [ 4 ].…”

Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics

“…The retrospective nature of the study did not allow the exclusion of hidden confounders such as preexisting cardiac or pulmonary diseases or other comorbidities that could affect the findings and the outcomes. A PE response team (PERT) is a multidisciplinary team established to improve the clinical care for patients with PE [ 21 , 22 ]. Although Rapid Response Teams (RRT) are always available in our institution, however, specialized teams that deal with PE such as the PERT are not.…”