Vol 26, No 6 (2019)
POSITION PAPER
Published online: 2020-01-22
Expert opinion on the creating and operating of the regional Pulmonary Embolism Response Teams (PERT). Polish PERT Initiative
1
, 2, 3, 4, 2, 5, 6, 7, 8, 3, 9, 1, 4, 2
, 2, 3, 4, 2, 5, 6, 7, 8, 3, 9, 1, 4, 2
Abstract
Pulmonary Embolism Response Team (PERT) is a multidisciplinary team established to stratify risk
and choose optimal treatment in patients with acute pulmonary embolism (PE). Established for the
first time at Massachusetts General Hospital in 2013, PERT is based on a concept combining a Rapid
Response Team and a Heart Team. The growing role of PERTs in making individual therapeutic decisions
is identified, especially in hemodynamically unstable patients with contraindications to thrombolysis or
with co-morbidities, as well as in patients with intermediate-high risk in whom a therapeutic decision
may be difficult. The purpose of this document is to define the standards of PERT under Polish conditions,
based on the experience of teams already operating in Poland, which formed an agreement called
the Polish PERT Initiative. The goals of Polish PERT Initiative are: improving the treatment of patients
with PE at local, regional and national levels, gathering, assessing and sharing data on the effectiveness
of PE treatment (including various types of catheter-directed therapy), education on optimal treatment
of PE, creating expert documents and supporting scientific research, as well as cooperation with other
communities and scientific societies.
Keywords: pulmonary embolismpulmonary embolism response teamcatheter-directed therapyembolectomy
References
- Cohen AT, Agnelli G, Anderson FA, et al. VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007; 98(4): 756–764.
- Goldhaber S, Bounameaux H. Pulmonary embolism and deep vein thrombosis. The Lancet. 2012; 379(9828): 1835–1846.
- Konstantinides S, Meyer G. Task Force for the Management of Acute Pulmonary Embolism of the European Society of C. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed with collaboratin with European Respiratory Society (ERS). Eur Heart J. 2019; 40(42): 3453–3455.
- Goldhaber SZ, Haire WD, Feldstein ML, et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet. 1993; 341(8844): 507–511.
- Budaj-Fidecka A, Kurzyna M, Fijałkowska A, et al. In-hospital major bleeding predicts mortality in patients with pulmonary embolism: an analysis of ZATPOL Registry data. Int J Cardiol. 2013; 168(4): 3543–3549.
- 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.
- Chatterjee S, Chakraborty A, Weinberg I, et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA. 2014; 311(23): 2414–2421.
- Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med. 2012; 125(5): 465–470.
- Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000; 101(24): 2817–2822.
- Schultz J, Andersen A, Kabrhel C, et al. Catheter-based therapies in acute pulmonary embolism. EuroIntervention. 2018; 13(14): 1721–1727.
- 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(4): 479–486.
- 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.
- 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 (1995). 2014; 42(1): 31–37.
- Kabrhel C, Jaff MR, Channick RN, et al. A multidisciplinary pulmonary embolism response team. Chest. 2013; 144(5): 1738–1739.
- Dudzinski DM, Piazza G. Multidisciplinary pulmonary embolism response teams. Circulation. 2016; 133(1): 98–103.
- 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(2): 384–393.
- Barnes GD, Kabrhel C, Courtney DM, et al. Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members. Chest. 2016; 150(6): 1414–1417.
- 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(1): 31–40.
- 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 [Epub ahead of print]: 2045894018824563.
- Bova C, Sanchez O, Prandoni P, et al. Identification of intermediate-risk patients with acute symptomatic pulmonary embolism. Eur Respir J. 2014; 44(3): 694–703.
- Kurzyna M, Araszkiewicz A, Błaszczak P, et al. Summary of recommendations for the haemodynamic and angiographic assessment of the pulmonary circulation. Joint statement of the Polish Cardiac Society's Working Group on Pulmonary Circulation and Association of Cardiovascular Interventions. Kardiol Pol. 2015; 73(1): 63–68.
- Engelberger RP, Kucher N, Engelberger RP, et al. Catheter-based reperfusion treatment of pulmonary embolism. Circulation. 2011; 124(19): 2139–2144.
- Bajaj NS, Kalra R, Arora P, et al. Catheter-directed treatment for acute pulmonary embolism: Systematic review and single-arm meta-analyses. Int J Cardiol. 2016; 225: 128–139.
- Roik M, Wretowski D, Łabyk A, et al. Initial experience of pulmonary embolism response team with percutaneous embolectomy in intermediate-high- and high-risk acute pulmonary embolism. Kardiol Pol. 2019; 77(2): 228–231.
- Roik M, Wretowski D, Machowski M, et al. Successful treatment of intermediate-high-risk pulmonary embolism with aspiration thrombectomy: first experience in Poland. Kardiol Pol. 2018; 76(9): 1381.
- Latacz P, Simka M, Brzegowy P, et al. Treatment of high- and intermediate-risk pulmonary embolism using the AngioJet percutaneous mechanical thrombectomy system in patients with contraindications for thrombolytic treatment - a pilot study. Wideochir Inne Tech Maloinwazyjne. 2018; 13(2): 233–242.
- Stępniewski J, Kopeć G, Magoń W, et al. Ultrasound‑assisted, catheter‑directed, low‑dose thrombolysis for the treatment of acute intermediate‑high risk pulmonary embolism. Pol Arch Intern Med. 2018; 128(6): 394–395.
- Kurzyna M, Pietrasik A, Opolski G, et al. Contemporary methods for the treatment of pulmonary embolism - is it prime-time for percutaneous interventions? Kardiol Pol. 2017; 75(11): 1161–1170.
- Araszkiewicz A, Jankiewicz S, Sławek-Szmyt S, et al. Rapid clinical and haemodynamic improvement in a patient with intermediate-high risk pulmonary embolism treated with transcatheter aspiration thrombectomy. Adv Interv Cardiol. 2019; 15(4): 497–498.
- Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. NEJM. 1998; 338(7): 409–416.
- PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 2005; 112(3): 416–422.
- Stein PD, Matta F, Lawrence FR, et al. Inferior Vena Cava Filters in Patients with Acute Pulmonary Embolism and Cancer. Am J Med. 2018; 131(4): 442.e9–442.e12.
- Charalel RA, Durack JC, Mao J, et al. Statewide inferior vena cava filter placement, complications, and retrievals: epidemiology and recent trends. Med Care. 2018; 56(3): 260–265.
- Meneveau N, Séronde MF, Blonde MC, et al. Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest. 2006; 129(4): 1043–1050.
- Myers PO, Bounameaux H, Panos A, et al. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest. 2010; 137(1): 164–170.
- Stefaniak S, Puślecki M, Ligowski M, et al. Venoarterial extracorporeal membrane oxygenation in massive pulmonary embolism. Kardiol Pol. 2018; 76(5): 931.
- Puślecki M, Ligowski M, Dąbrowski M, et al. "ECMO for Greater Poland": a unique regional program for extracorporeal life support. Pol Arch Intern Med. 2017; 127(7-8): 567–568.
- Puślecki M, Ligowski M, Stefaniak S, et al. "Extracorporeal Membrane Oxygenation for Greater Poland" Program: how to save lives and develop organ donation? Transplant Proc. 2018; 50(7): 1957–1961.
