The establishment of multidisciplinary pulmonary embolism response teams (PERTs) has the potential to fast-track optimal care for high and intermediate risk PE patients.
Respiratory physician Dr Jimmy Chien, clinical lead for the PERT at Westmead Hospital, told TSANZSRS 2024 that management of PE generally remained quite variable despite being common and life threatening.
He said a 2022 scoping review and meta-analysis of PERTs [link here] had identified some of their likely advantages, including:
- Reduced variability in therapeutic approach
- Improved risk stratification
- Improved selection of advanced therapies
- Help navigating the gaps in guidelines and evidence
- Education of peers and trainees
- Leveraging the unique perspectives of other specialists
- Fostering pathways for patient follow-up.
Dr Chien said the Westmead PERT took years to set up – from formation of a working group in 2016 through drafting algorithms, establishing consensus, PERT management of a trial cohort, simulation sessions, formal clinical governance and executive support, and review of early outcomes.
A description of the first 36 months of the Westmead PERT which managed 75 consecutive patients between August 2018 and July 2021 has just been published in the Internal Medicine Journal [link here].
The PERT consists of specialists from respiratory medicine, emergency, haematology, interventional radiology, and intensive care, with cardiothoracic and vascular surgeons participating as required.
It is activated by the on-call respiratory physician for any patient with acute PE thought to require urgent multidisciplinary input. Patients were mostly classified as intermediate-high risk (59%) and high-risk (24%) according to ESC guidelines.
About 22% had a history of VTE, 31% had hypertension, 31% had a solid malignancy and 26% had a period of recent immobilisation. As well, over 85% of patients had a sPESI score≥1, conferring a high mortality risk.
The study said all patients managed by the PERT received therapeutic anticoagulation prior to or shortly after PERT activation.