Related article

by Araszkiewicz et al.

see p. 1311

Acute pulmonary embolism (PE) remains a leading cause of death worldwide [1]. The care of PE patients, particularly those with intermediate and high-risk PE, is highly complex [2]. Indeed, the best treatment is unknown, and there is no standard approach. Historically, there has not been a well-organized, structured, systematic approach to acute PE management, with significant heterogeneity and inconsistencies in therapeutic decision-making. Options are myriad, including anticoagulation alone, systemic full dose or low dose thrombolysis, catheter directed low dose thrombolysis, catheter aspiration thrombectomy, surgical embolectomy, and insertion of a vena cava filter. These therapeutic options are performed by different specialists, without a single team coordinating and directing care. Practice varies significantly by location and resources. A small proportion of eligible PE patients receive advanced reperfusion therapies. Reasons for this underutilization include failure to recognize potential benefit and integrate data in real time, inability to respond rapidly due to systems barriers, fear of complications and paralysis in decision-making in the setting of life-threatening situations [3].

The concept of a single PE response team (PERT) emerged as a response to this status quo. While the composition and operations of these teams vary across institutions, there are some key characteristics that a PERT should have. A PERT is a multidisciplinary team of experts in the care of PE, with a centralized unique activation process, that can provide rapid assessment and risk stratification of the PE patient, formulate an individualized treatment approach, and facilitate the implementation of the recommended therapeutic strategy [3, 4]. The PERT concept was initially established in the USA in 2012 at the Massachusetts General Hospital (MGH) [5]. The concept disseminated rapidly in the USA, leading to the formation of the PERT consortium [6]. Now, the PERT concept is going global.

Araszkiewicz et al. [7] report the use of systemic anticoagulation alone in 80% of PERT activations, higher rates than prior retrospective reports [5, 11], but consistent with the notion that most acute PE patients cared for by PERT teams do well with anticoagulation alone. While the implementation of PERT teams is associated with an increased use of advanced PE therapies, these invasive and riskier strategies should not be used liberally, and are best utilized in experienced operators’ hands, depending on the local resources and expertise, and in the context of an individualized treatment plan. For example, completely occlusive acute PE disease in an unstable patient might be best treated with a catheter based procedure, as systemically infused thrombolytics are unlikely to be effective [12]. The ongoing PEITHO-3 and HI-PEITHO randomized trials will hopefully elucidate the best patients’ clinical phenotypes for the use of low-dose systemic thrombolysis and ultrasound facilitated, catheter-directed thrombolysis, respectively [13, 14].

The availability of a PERT allows clinicians to balance the pros and cons of advanced or invasive therapeutic maneuvers for a given patient with acute PE. Of course, such teams, as defined above, are challenging to implement and can impose a burden on participating specialists. Different institutions should tailor specifics of PERT logistics to leverage their local expertise and resources. Emerging data point to the fact that the multidisciplinary approach of PERT leads to improved outcomes and safety. In that context, we are pleased to see the PERT concept go global. However, much remains to be learned about the composition, operations, logistics and impact of PERTs across the world. We need more reports such as the excellent work presented here.

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Conflict of interest: None declared.

Open access: This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. For commercial use, please contact the journal office at kardiologiapolska@ptkardio.pl.

How to cite: Heresi GA, Porres-Aguilar M. Pulmonary embolism response teams: A concept in progress and beyond borders. Kardiol Pol. 2021; 79(12): 1301–1302, doi: 10.33963/KP.a2021.0174.

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