The Current Evidence of Pulmonary Embolism Response Teams and Their Role in Future

Abstract

Acute pulmonary embolism (PE) remains a critical medical condition requiring prompt and accurate management. The introduction and growing significance of pulmonary embolism response teams (PERT), also termed EXPERT-PE teams, signify a paradigm shift toward a collaborative, multidisciplinary approach in managing this complex entity. As the understanding of acute PE continues to evolve, PERTs stand as a linkage of optimized care, offering personalized and evidence-based management strategies for patients afflicted by this life-threatening condition. The evolving role of PERTs globally is evident in their increasing integration into the standard care pathways for acute PE. These teams have demonstrated benefits such as reducing time to diagnosis and treatment initiation, optimizing resource utilization, and improving patient outcomes.

Keywords

pulmonary embolism - PERT - catheter-directed treatment - ultrasound-accelerated thrombolysis - percutaneous thrombectomy

Publication History

Received: 11 September 2023

Accepted: 18 December 2023

Article published online:
12 March 2024

• References

• 1 Konstantinides SV, Meyer G. The 2019 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2019; 40 (42) 3453-3455
• 2 Keller K, Hobohm L, Ebner M. et al. Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany. Eur Heart J 2020; 41 (04) 522-529
• 3 Kucher N, Boekstegers P, Müller OJ. et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation 2014; 129 (04) 479-486
• 4 Sista AK, Horowitz JM, Tapson VF. et al; EXTRACT-PE Investigators. Indigo aspiration system for treatment of pulmonary embolism: results of the EXTRACT-PE trial. JACC Cardiovasc Interv 2021; 14 (03) 319-329
• 5 Toma C, Khandhar S, Zalewski AM, D'Auria SJ, Tu TM, Jaber WA. Percutaneous thrombectomy in patients with massive and very high-risk submassive acute pulmonary embolism. Catheter Cardiovasc Interv 2020; 96 (07) 1465-1470
• 6 Fleitas Sosa D, Lehr AL, Zhao H. et al. Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis. Eur Respir Rev 2022; 31 (165) 220023
• 7 Hobohm L, Farmakis IT, Keller K. et al. Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis. Clin Res Cardiol 2023; 112 (10) 1351-1361
• 8 Becattini C, Agnelli G, Vedovati MC. et al. Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. Eur Heart J 2011; 32 (13) 1657-1663
• 9 Barco S, Schmidtmann I, Ageno W. et al; HoT-PE Investigators. Early discharge and home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban: an international multicentre single-arm clinical trial. Eur Heart J 2020; 41 (04) 509-518
• 10 Jiménez D, Aujesky D, Moores L. et al; RIETE Investigators. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010; 170 (15) 1383-1389
• 11 Chopard R, Nielsen P, Ius F. et al. Optimal reperfusion strategy in acute high-risk pulmonary embolism requiring extracorporeal membrane oxygenation support: a systematic review and meta-analysis. Eur Respir J 2022; 60 (05) 2102977
• 12 Hobohm L, Keller K, Münzel T, Gori T, Konstantinides SV. EkoSonic® endovascular system and other catheter-directed treatment reperfusion strategies for acute pulmonary embolism: overview of efficacy and safety outcomes. Expert Rev Med Devices 2020; 17 (08) 739-749
• 13 Bejjani A, Khairani CD, Campia U, Piazza G. Pulmonary embolism response teams: theory, implementation, and unanswered questions. J Clin Med 2022; 11 (20) 6129
• 14 Konstantinides SV, Meyer G, Becattini C. et al; ESC Scientific Document Group. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41 (04) 543-603
• 15 Giri J, Sista AK, Weinberg I. et al. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association. Circulation 2019; 140 (20) e774-e801
• 16 Hobohm L, Sagoschen I, Barco S. et al. COVID-19 infection and its impact on case-fatality in patients with pulmonary embolism. Eur Respir J 2023; 61 (01) 2200619
• 17 Rosovsky R, Borges J, Kabrhel C, Rosenfield K. Pulmonary embolism response team: inpatient structure, outpatient follow-up, and is it the current standard of care?. Clin Chest Med 2018; 39 (03) 621-630
• 18 Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of pulmonary embolism: an update. J Am Coll Cardiol 2016; 67 (08) 976-990
• 19 Porres-Aguilar M, Rosovsky RP, Rivera-Lebron BN. et al. Pulmonary embolism response teams: changing the paradigm in the care for acute pulmonary embolism. J Thromb Haemost 2022; 20 (11) 2457-2464
• 20 Jaff MR, McMurtry MS, Archer SL. et al; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, ; American Heart Association Council on Peripheral Vascular Disease, ; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123 (16) 1788-1830
• 21 Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med 2012; 125 (05) 465-470
• 22 Dudzinski DM, Piazza G. Multidisciplinary pulmonary embolism response teams. Circulation 2016; 133 (01) 98-103
• 23 Kabrhel C, Rosovsky R, Channick R. et al. A multidisciplinary pulmonary embolism response team: initial 30-month experience with a novel approach to delivery of care to patients with submassive and massive pulmonary embolism. Chest 2016; 150 (02) 384-393
• 24 Myc LA, Solanki JN, Barros AJ. et al. Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism. Respir Res 2020; 21 (01) 159
• 25 Schultz J, Giordano N, Zheng H. et al. EXPRESS: a multidisciplinary pulmonary embolism response team (PERT): experience from a national multicenter consortium. Pulm Circ 2019; 9 (03) 2045894018824563
• 26 Sista AK, Friedman OA, Dou E. et al. A pulmonary embolism response team's initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism. Vasc Med 2018; 23 (01) 65-71
• 27 Wiske CP, Shen C, Amoroso N. et al. Evaluating time to treatment and in-hospital outcomes of pulmonary embolism response teams. J Vasc Surg Venous Lymphat Disord 2020; 8 (05) 717-724
• 28 Xenos ES, Davis GA, He Q, Green A, Smyth SS. The implementation of a pulmonary embolism response team in the management of intermediate- or high-risk pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2019; 7 (04) 493-500
• 29 Wright C, Goldenberg I, Schleede S. et al. Effect of a multidisciplinary pulmonary embolism response team on patient mortality. Am J Cardiol 2021; 161: 102-107
• 30 Carroll BJ, Beyer SE, Mehegan T. et al. Changes in care for acute pulmonary embolism through a multidisciplinary pulmonary embolism response team. Am J Med 2020; 133 (11) 1313-1321.e6
• 31 Chaudhury P, Gadre SK, Schneider E. et al. Impact of multidisciplinary pulmonary embolism response team availability on management and outcomes. Am J Cardiol 2019; 124 (09) 1465-1469
• 32 Annabathula R, Dugan A, Bhalla V, Davis GA, Smyth SS, Gupta VA. Value-based assessment of implementing a pulmonary embolism response team (PERT). J Thromb Thrombolysis 2021; 51 (01) 217-225
• 33 Deadmon EK, Giordano NJ, Rosenfield K. et al. Comparison of emergency department patients to inpatients receiving a pulmonary embolism response team (PERT) activation. Acad Emerg Med 2017; 24 (07) 814-821
• 34 Mortensen CS, Kramer A, Schultz JG. et al. Predicting factors for pulmonary embolism response team activation in a general pulmonary embolism population. J Thromb Thrombolysis 2022; 53 (02) 506-513
• 35 Araszkiewicz A, Kurzyna M, Kopeć G. et al; Polish PERT Initiative. Expert opinion on the creating and operating of the regional pulmonary embolism response teams (PERT). Cardiol J 2019; 26 (06) 623-632
• 36 Toro-Mijares RD, Jerjes-Sánchez C, Rodríguez D. et al. The Hospital Zambrano Hellion venous thromboembolism rapid response team (PREVENTION-team): Improving pulmonary embolism and deep venous thrombosis patient care. Arch Cardiol Mex 2020; 90 (01) 28-38
• 37 Wang X, Ji Q, Rosenfield K, Tapson V, Nie S. Multidisciplinary pulmonary embolism response team in China: a nationwide survey. Respirology 2021; 26 (04) 392-393
• 38 Romano KR, Cory JM, Ronco JJ, Legiehn GM, Bone JN, Finlayson GN. Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience. Can J Anaesth 2020; 67 (12) 1806-1813
• 39 Jen WY, Kristanto W, Teo L. et al. Assessing the impact of a pulmonary embolism response team and treatment protocol on patients presenting with acute pulmonary embolism. Heart Lung Circ 2020; 29 (03) 345-353
• 40 Lojo-Lendoiro S, López-Zárraga F. The implication of including interventional radiologists in multidisciplinary pulmonary embolism treatment teams. Arch Bronconeumol 2023; 59 (01) 1-2
• 41 Galmer A, Weinberg I, Giri J, Jaff M, Weinberg M. The role of the pulmonary embolism response team: how to build one, who to include, scenarios, organization, and algorithms. Tech Vasc Interv Radiol 2017; 20 (03) 216-223
• 42 Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation 2006; 113 (04) 577-582
• 43 Hobohm L, Sagoschen I, Habertheuer A. et al. Clinical use and outcome of extracorporeal membrane oxygenation in patients with pulmonary embolism. Resuscitation 2022; 170: 285-292
• 44 Pruszczyk P, Klok FA, Kucher N. et al. Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention 2022; 18 (08) e623-e638
• 45 Meyer G, Vicaut E, Danays T. et al; PEITHO Investigators. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014; 370 (15) 1402-1411
• 46 Percy ED, Shah R, Hirji S. et al. National outcomes of surgical embolectomy for acute pulmonary embolism. Ann Thorac Surg 2020; 110 (02) 441-447
• 47 Toma C, Jaber WA, Weinberg MD. et al. Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism. EuroIntervention 2023; 18 (14) 1201-1212
• 48 Piazza G, Hohlfelder B, Jaff MR. et al; SEATTLE II Investigators. A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study. JACC Cardiovasc Interv 2015; 8 (10) 1382-1392
• 49 Tapson VF, Sterling K, Jones N. et al. A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE Trial. JACC Cardiovasc Interv 2018; 11 (14) 1401-1410
• 50 Avgerinos ED, Saadeddin Z, Abou Ali AN. et al. A meta-analysis of outcomes of catheter-directed thrombolysis for high- and intermediate-risk pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2018; 6 (04) 530-540
• 51 Klok FA, Piazza G, Sharp ASP. et al. Ultrasound-facilitated, catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: rationale and design of the HI-PEITHO study. Am Heart J 2022; 251: 43-53
• 52 Sedhom R, Megaly M, Elbadawi A. et al. Contemporary national trends and outcomes of pulmonary embolism in the United States. Am J Cardiol 2022; 176: 132-138
• 53 Kucher N, Ouda A, Voci D. et al. Percutaneous large-bore aspiration embolectomy with veno-arterial extracorporal membrane oxygenation support or standby in patients with high-risk pulmonary embolism and contraindications to thrombolysis: a preliminary single centre experience. Eur Heart J Acute Cardiovasc Care 2023; 12 (04) 232-236
• 54 Provias T, Dudzinski DM, Jaff MR. et al. The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT): creation of a multidisciplinary program to improve care of patients with massive and submassive pulmonary embolism. Hosp Pract 2014; 42 (01) 31-37
• 55 Ardeshna NS, Song M, Hyder SN. et al. Effect of pulmonary embolism response team on advanced therapies administered: the University of Michigan experience. Thromb Res 2023; 221: 73-78
• 56 Melamed R, St Hill CA, Engstrom BI. et al. Effects of a consensus-based pulmonary embolism treatment algorithm and response team on treatment modality choices, outcomes, and complications. Clin Appl Thromb Hemost 2020; 26: 1076029620928420
• 57 Rosovsky R, Chang Y, Rosenfield K. et al. Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis. J Thromb Thrombolysis 2019; 47 (01) 31-40
• 58 Araszkiewicz A, Kurzyna M, Kopeć G. et al. Pulmonary embolism response team: a multidisciplinary approach to pulmonary embolism treatment. Polish PERT initiative report. Kardiol Pol 2021; 79 (12) 1311-1319
• 59 Finn MT, Gogia S, Ingrassia JJ. et al. Pulmonary embolism response team utilization during the COVID-19 pandemic. Vasc Med 2021; 26 (04) 426-433
• 60 Groth CM, Acquisto NM, Wright C. et al. Pharmacists as members of an interdisciplinary pulmonary embolism response team. J Am Coll Clin Pharm 2022; 5 (04) 390-397
• 61 Kendall MR, Swadron S, Clavijo LC. et al. Use of the STEMI team for treatment of patients with pulmonary embolism: a pilot study. J Invasive Cardiol 2018; 30 (10) 367-371
• 62 Khaing P, Paruchuri A, Eisenbrey JR. et al. First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation. Hosp Pract (1995) 2020; 48 (01) 23-28
• 63 Kwok B, Brosnahan SB, Amoroso NE. et al. Pulmonary embolism response team activation during the COVID-19 pandemic in a New York City Academic Hospital: a retrospective cohort analysis. J Thromb Thrombolysis 2021; 51 (02) 330-338
• 64 Parikh M, Chahine NM, Hammad TA. et al. Predictors and potential advantages of PERT and advanced therapy use in acute pulmonary embolism. Catheter Cardiovasc Interv 2021; 97 (07) 1430-1437