A pulmonary embolism response team (PERT) approach: initial experience from the Cleveland Clinic

Mahar, Jamal; Haddadin, Ihab; Sadana, Divyajot; Gadre, Abishek; Evans, Natalie; Hornacek, Deborah; Mahlay, Natalia Fendrikova; Gomes, Marcelo; Joseph, Douglas; Serhal, Maya; Tong, Michael; Bauer, Seth; Militello, Michael; Silver, Bernard J.; Shishehbor, Mehdi H.; Bartholomew, John R.; Heresi, Gustavo A.

doi:10.1007/s11239-018-1686-2

Cited by 44 publications

(43 citation statements)

References 15 publications

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“…As such, there are no randomized controlled trial data or robust clinical evidence evaluating the PERT approach, though efforts are under way to bridge this gap . Current available data from 12 prospective and retrospective studies are summarized in Table . To identify these published studies on PERT, we conducted a similar systematic search of the literature as we did for Table .…”

Section: Evidence For Efficacy Of Pertmentioning

confidence: 99%

“…An interrupted time series analysis demonstrates an increase in the proportion of PE patients undergoing any advanced therapy, from 9% to 19%, after the introduction of PERT . This increase is largely attributed to greater utilization of CDT, which grew from 1% to 14%, and reports from other PERT institutions show similar use of CDT . Possible reasons for the increase in CDT cases include (1) greater awareness and recognition of severe PE, (2) inclusion of interventional specialties in the management of PE, (3) evidence from the PEITHO trial that systemic thrombolysis prevents hemodynamic decompensation in intermediate‐risk PE, and (4) the perception that CDT causes less bleeding than systemic thrombolysis .…”

Section: Evidence For Efficacy Of Pertmentioning

confidence: 99%

“…While the growth of the PERT model has been exponential, and numerous manuscripts have been published describing the development of similar teams (Tables and ), objective evidence confirming the effectiveness of the approach is still limited. Most of the research studies published to date are descriptive in nature . While these studies have been helpful in describing the PERT model and expected effect of implementation, several key questions remain to be answered.…”

Section: Future Directions For Researchmentioning

confidence: 99%

“…Several studies provide evidence that PERTs frequently employ interventional approaches in the treatment of PE. For example, reports from 3 PERT centers (MGH, Cleveland Clinic, and New York University) indicate that CDT is used in 5% to 32% of high‐risk PE, and 9% to 27% of intermediate‐risk PE . A single‐center report from MGH also found a significant increase in the use of advanced therapy and CDT after the implementation of the PERT program …”

Section: Future Directions For Researchmentioning

confidence: 99%

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Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions

Rosovsky

Zhao

Sista

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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Pulmonary embolism (PE) is a major cause of morbidity and mortality in the United States. Although new therapeutic tools and strategies have recently been developed for the diagnosis and treatment of patients with PE, the outcomes for patients who present with massive or high‐risk PE remain dismal. To address this crisis, pulmonary embolism response teams (PERTs) are being created around the world in an effort to immediately and simultaneously engage multiple specialists to determine the best course of action and coordinate the clinical care for patients with acute PE. The scope of this review is to describe the PERT model and purpose, present the structure and organization, examine the available evidence for efficacy and usefulness, and propose future directions for research that is needed to demonstrate the value of PERT and determine if this multidisciplinary approach represents a new standard of care.

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Section: Evidence For Efficacy Of Pertmentioning

confidence: 99%

Section: Evidence For Efficacy Of Pertmentioning

confidence: 99%

Section: Future Directions For Researchmentioning

confidence: 99%

Section: Future Directions For Researchmentioning

confidence: 99%

See 2 more Smart Citations

Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions

Rosovsky

Zhao

Sista

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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“…The use of Pulmonary Embolism Response Teams (PERTs) to rapidly assess patient risk and to institute a treatment algorithm for patients with submassive and massive PE has gained popularity around the world, and may improve both mortality and the efficiency of treatment in acute care environments such as the emergency department [15][16][17][18] . Prognostic information obtained during expedited patient evaluation may influence the choice of advanced treatment options and recently was reported as an independent variable predicting mortality 19 .…”

mentioning

confidence: 99%

Categorical Assignment of Pulmonary Embolism is a Simple and More Accurate Indicator of Right Ventricular Dysfunction and Short Team Mortality

Chen¹,

Wright

Pietropaoli

et al. 2019

Preprint

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word count: 285. Manuscript word count: 2325Abstract Several risk stratification tools are available to predict short-term mortality in patients with acute pulmonary embolism (PE). Right ventricular (RV) dysfunction, which is common to intermediate and high risk PE, is an independent predictor of mortality and may be a faster and simpler way to assess patient risk in acute care settings.We evaluated 571 patients presenting with acute PE as the primary diagnosis, stratifying them by the Pulmonary Embolism Severity Index (PESI), by the BOVA score, or categorically as low risk (no RV dysfunction by imaging), intermediate risk (RV dysfunction by imaging), or high risk PE (RV dysfunction by imaging with sustained hypotension). Using imaging data to firstly define the presence of RV dysfunction, and plasma cardiac troponin T (cTnT) and NT-proBNP as additional evidence for myocardial strain, we evaluated the PESI and BOVA scoring systems compared to categorical assignment of PE as low risk, submassive, and massive PE. Cardiac biomarkers poorly distinguished between PESI classes and BOVA stages in patients with acute PE. Cardiac TnT and NT-proBNP easily distinguished low risk from submassive PE with an area under the curve (AUC) of 0.84 (95% C.I. 0.73 -0.95, p< 0.0001), and 0.88 (95% C.I. 0.79-0.97, p< 0.0001), respectively, and low risk from massive PE with an area under the curve (AUC) of 0.89 (95% C.I. 0.78 -1.00, p< 0.0001), and 0.89 (95% C.I. 0.82-0.95, p<0.0001), respectively. Predicted short-term mortality by PESI score or BOVA stage was lower than the observed mortality for submassive PE by a two-fold order of magnitude.These data suggest the presence of RV dysfunction in the context of acute PE is sufficient for the purposes of risk stratification, while more complicated risk stratification algorithms may under-estimate short-term mortality risk.

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Reduction in thrombolytic order‐to‐needle time with addition of a pharmacist to a pulmonary embolism response team

Berdahl

Cascone

Ackerbauer

et al. 2023

J Am Coll Clin Pharm

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Introduction Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States. Institutions have implemented pulmonary embolism response teams (PERT) to hasten clinical decision making and therapeutic interventions. The extent to which critical care pharmacists are included in PERTs is not known. Although improved outcomes with pharmacist involvement in other emergency response teams (e.g., stroke teams) is well described, literature surrounding the impact of pharmacist inclusion in PERTs is limited. The objective was to evaluate if direct pharmacist inclusion in a PERT resulted in reduced time to systemic thrombolysis from time of medication order release in appropriate PE candidates. Methods This was a retrospective, observational study of patients with submassive or massive PE who received systemic thrombolysis at a large academic medical center. Patients were divided into two groups based on if they received systemic thrombolysis before or after the intervention. This intervention was the addition of a pharmacist to the PERT with emphasis on early communication between the PERT pharmacist and other stakeholders at time of PERT activation, and a revised thrombolytic preparation workflow emphasizing bedside preparation by the pharmacist. The primary outcome was time to administration of thrombolytic from time of medication order release. Results Thirty‐four patients were included. Median time to thrombolytic administration was reduced in the post‐intervention group compared to the pre‐intervention group (23 min [14.8–42] vs. 54 min [42.8–69], p = 0.007). Bleeding events were not different between groups. Time to resumption of systemic anticoagulation after systemic thrombolysis was greater in the post‐intervention group. Conclusion Inclusion of a pharmacist in the PERT at this institution significantly reduced time to administration of systemic thrombolysis from time of medication order release in appropriate PE candidates. Larger studies should be conducted to expand upon and confirm these findings.

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A pulmonary embolism response team (PERT) approach: initial experience from the Cleveland Clinic

Cited by 44 publications

References 15 publications

Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions

Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions

Categorical Assignment of Pulmonary Embolism is a Simple and More Accurate Indicator of Right Ventricular Dysfunction and Short Team Mortality

Reduction in thrombolytic order‐to‐needle time with addition of a pharmacist to a pulmonary embolism response team

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