Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience

Abstract

Purpose Clinical equipoise exists with the use of novel reperfusion therapies such as catheter-directed thrombolysis in the management of patients presenting to hospital with high risk pulmonary embolism (PE). Therapeutic options rely on clinical presentation, patient factors, physician preference, and institutional availability. We established a Pulmonary Embolism Response Team (PERT) to provide urgent assessment and multidisciplinary care for patients presenting to our institution with high-risk PE. Methods Data were retrospectively collected from PERT activations between January 2016 and December 2018. Chi square tests were used to determine differences in mortality across the three years of study. Logistic regression was used to evaluate 30-and 90-day mortality and occurrence of major bleeds between those receiving anticoagulation alone (AC) and those receiving advanced reperfusion therapy (ART). Results There were 128 PERT activations over three years, the majority originating from the emergency department. Eighty-five percent of activations were for submassive PE, with 56% of all activations assessed as submassive-high risk. Fifteen patients (12%) presented with massive PE. Advanced reperfusion therapy was used in 29 (23%) patients, of whom 25 (20%) received catheterdirected thrombolysis. There was an increased risk of major bleeding in the ART group compared with in the AC group (odds ratio [OR], 17.9; 95% confidence interval [CI], 4.1 to 125.0; P \ 0.001), but no increased risk of mortality at 30 days (OR, 2.1; 95% CI, 0.4 to 9.1; P = 0.3). The 30-day mortality rate was 7.8%. Conclusion We describe the first Canadian PERT, a multidisciplinary team aimed at providing urgent individualized care for patients with high-risk PE. Further research is necessary to determine whether a PERT improves clinical outcomes.

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

“…The complexity of diagnosis, the clinical course, and treatment options of PE in real-time integrated clinical care require coordinated multispecialty consultation and decision-making. To facilitate this, the institutionally based pulmonary embolism response team (PERT) model of PE management was recently developed in the United States and across Europe [10][11][12][13][14][15]. PERT consists of specialists from different disciplines, including cardiologists, interventional cardiologists, cardiac surgeons, vascular surgeons, radiologists, and anesthesiologists, who rapidly evaluate, coordinate, and provide a full range of advanced treatment modalities for complex PE ceases.…”

“…PERT members, in cooperation with referring physicians, determine the most appropriate treatment strategy individually for each patient. The strategy consists of anticoagulation alone or systemic thrombolysis, surgical embolectomy (SE), or CDT [10][11][12][13][14][15]. Several PERTs have already been established in Poland [17][18][19].…”

Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis

“…The searches yielded 2119 citations, 1794 from databases and 325 from grey literature search citations. After duplicates were removed, 1545 studies underwent title and abstract review, after which 22 studies remained [5,6,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Of these studies, six were excluded after reviewing the full-text manuscript.…”

“…We included 16 studies [5,6,[12][13][14][15][16][17][18][19][20][21][22][23][24][25] published between 2016 and 2020 and all were single-centre studies from academic institutions. They incorporated patients who were evaluated and treated from August 2012 to April 2020.…”

Evolving Management Trends and Outcomes in Catheter Management of Acute Pulmonary Embolism

“…This ambiguity has led to hospitals creating PERTs responsible for the identification and risk stratification of patients presenting with PE. 52,53 Although the exact constituents of PERTs varies, the ultimate goal is to have an expert multidisciplinary team able to rapidly evaluate PE patients for medical, surgical, and endovascular therapies. Several recent studies analyzing the efficacy of PERTs have shown a significant increase in the utilization of STT and CDTs in massive PE and a decrease in intensive care unit length of stay and decrease in elapsed time from diagnosis to therapeutic anticoagulation following the creation of a PERT without a change in major bleeding or overall cost.…”