A Multidisciplinary Pulmonary Embolism Response Team (PERT) –Initial 30-Month Experience with a Novel Approach to Delivery of Care to Patients with Sub-Massive and Massive PE

Introduction

Integrating newly developed tests and treatments for severe pulmonary embolism (PE) into clinical care requires coordinated multi-specialty collaboration. To meet this need, we developed a new paradigm: a multidisciplinary Pulmonary Embolism Response Team (PERT). In this report, we provide the first longitudinal analysis of patients treated by a PERT.

Methods

Our PERT includes specialists in cardiovascular medicine and surgery, emergency medicine, hematology, pulmonary/critical care and radiology and is organized as a rapid response team. We prospectively captured clinical, therapeutic and outcome data at PERT activation and during follow-up periods up to 365 days. We analyzed data collectively, and as five mutually exclusive six-month time periods. We performed Fisher's exact tests and regression analysis to test for trend.

Results

In 30 months, there were 394 unique PERT activations, 314 (80%) for confirmed PE. PERT activations increased by 16% every six months. Most confirmed PE were submassive (n=143, 46%) or massive (n=80, 26%). The PERT treated a relatively large proportion of PE patients with systemic or catheter-directed thrombolysis (n=35, 11%), though the most common treatment was anticoagulation alone (n=215, 69%). Hemorrhagic complications were rare overall, especially among patients treated with catheter-directed thrombolysis. The all cause 30-day mortality of PERT patients with confirmed PE was 12%.

Conclusions

We report our initial 30-month experience with a novel multidisciplinary PERT that rapidly engages multiple specialists to deliver efficient, organized and evidence-based care to patients with high-risk PE. The PERT paradigm was rapidly adopted and may become a new standard-of-care for patients with PE.

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