Multidisciplinary approach to the management of pulmonary embolism patients: the pulmonary embolism response team (PERT)

Abstract

Christopher W Root,1 David M Dudzinski,2 Bishoy Zakhary,3 Oren A Friedman,4 Akhilesh K Sista,5 James M Horowitz6 1Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; 3Department of Internal Medicine, Oregon Health & Science University, Portland, OR, USA; 4Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 5Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, NY, USA; 6Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY, USA Abstract: Pulmonary embolism (PE) is a potentially fatal disease with a broad range of treatment options that spans multiple specialties. The rapid evolution and expansion of novel therapies to treat PE make it a disease process that is well suited to a multidisciplinary approach. In order to facilitate a rapid, robust response to the diagnosis of PE, some hospitals have established multidisciplinary pulmonary embolism response teams (PERTs). The PERT model is based on existing multidisciplinary teams such as heart teams and rapid response teams. A PERT is composed of clinicians from the range of specialties involved in the treatment of PE, including pulmonology critical care, interventional radiology, cardiology, and cardiothoracic surgery among others. A PERT is a 24/7 consult service that is able to provide expert advice on the initial management of PE patients and convene in real time to develop a consensus treatment plan specifically tailored to the needs of a particular patient and consistent with the capabilities of the institution. In this review, we discuss the rationale for establishing a PERT and its potential benefits. We discuss considerations in forming a PERT and present case studies of several PERTs currently in operation at different institutions. We also discuss potential difficulties in forming a PERT and review evidence that has been generated by some of the PERTs that have been in operation the longest. Keywords: pulmonary embolism, pulmonary embolism response team, thrombosis, thrombolysis, venous thromboembolism

Keywords

• Pulmonary Embolism
• Pulmonary Embolism Response Team
• Thrombosis
• Thrombolysis
• Venous Thromboembolism