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Open Access 17-08-2022 | Original Paper

Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis

Authors: Lukas Hobohm, Ioannis T. Farmakis, Karsten Keller, Barbara Scibior, Anna C. Mavromanoli, Ingo Sagoschen, Thomas Münzel, Ingo Ahrens, Stavros Konstantinides

Published in: Clinical Research in Cardiology | Issue 10/2023

Abstract

Background

Over the last years, multidisciplinary pulmonary embolism response teams (PERTs) have emerged to encounter the increasing variety and complexity in the management of acute pulmonary embolism (PE). We aimed to systematically investigate the composition and added clinical value of PERTs.

Methods

We searched PubMed, CENTRAL and Web of Science until January 2022 for articles designed to describe the structure and function of PERTs. We performed a random-effects meta-analysis of controlled studies (PERT vs. pre-PERT era) to investigate the impact of PERTs on clinical outcomes and advanced therapies use.

Results

We included 22 original studies and four surveys. Overall, 31.5% of patients with PE were evaluated by PERT referred mostly by emergency departments (59.4%). In 11 single-arm studies (1532 intermediate-risk and high-risk patients evaluated by PERT) mortality rate was 10%, bleeding rate 9% and length of stay 7.3 days [95% confidence interval (CI) 5.7–8.9]. In nine controlled studies there was no difference in mortality [risk ratio (RR) 0.89, 95% CI 0.67–1.19] by comparing pre-PERT with PERT era. When analysing patients with intermediate or high-risk class only, the effect estimate for mortality tended to be lower for patients treated in the PERT era compared to those treated in the pre-PERT era (RR 0.71, 95% CI 0.45–1.12). The use of advanced therapies was higher (RR 2.67, 95% CI 1.29–5.50) and the in-hospital stay shorter (mean difference − 1.6 days) in PERT era compared to pre-PERT era.

Conclusions

PERT implementation led to greater use of advanced therapies and shorter in-hospital stay. Our meta-analysis did not show a survival benefit in patients with PE since PERT implementation. Large prospective studies are needed to further explore the impact of PERTs on clinical outcomes.

Registration

Open Science Framework 10.17605/OSF.IO/SBFK9.

Graphical abstract

Available only for authorised users

Keller K, Hobohm L, Ebner M, Kresoja KP, Munzel T, Konstantinides SV, Lankeit M (2020) Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany. Eur Heart J 41:522–529CrossRefPubMed

Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jimenez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ni Ainle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL, and Group ESCSD (2020) ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 41:543–603CrossRefPubMed

Hobohm L, Keller K, Munzel T, Gori T, Konstantinides SV (2020) EkoSonic(R) endovascular system and other catheter-directed treatment reperfusion strategies for acute pulmonary embolism: overview of efficacy and safety outcomes. Expert Rev Med Devices 17:739–749CrossRefPubMed

Holmes DR Jr, Rich JB, Zoghbi WA, Mack MJ (2013) The heart team of cardiovascular care. J Am Coll Cardiol 61:903–907CrossRefPubMed

Rosovsky R, Chang Y, Rosenfield K, Channick R, Jaff MR, Weinberg I, Sundt T, Witkin A, Rodriguez-Lopez J, Parry BA, Harshbarger S, Hariharan P, Kabrhel C (2019) Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis. J Thromb Thrombolysis 47:31–40CrossRefPubMed

Dudzinski DM, Piazza G (2016) Multidisciplinary pulmonary embolism response teams. Circulation 133:98–103CrossRefPubMed

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tuncalp O, Straus SE (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169:467–473CrossRefPubMed

Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919CrossRefPubMedPubMedCentral

Wang X, Ji QW, Rosenfield K, Tapson V, Nie SP (2021) Multidisciplinary pulmonary embolism response team in China: a nationwide survey. Respirology 26:392–393CrossRefPubMed

10.

Todoran TM, Giri J, Barnes GD, Rosovsky RP, Chang YC, Jaff MR, Rosenfield K, Kabrhel C, and Consortium P (2018) Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the pulmonary embolism response team consortium. J Thromb Thrombol 46:39–49CrossRef

11.

Brailovsky Y, Kunchakarra S, Lakhter V, Barnes G, Masic D, Mancl E, Porcaro K, Bechara CF, Lopez JJ, Simpson K, Mathew V, Fareed J, Darki A (2020) Pulmonary embolism response team implementation improves awareness and education among the house staff and faculty. J Thromb Thrombolysis 49:54–58CrossRefPubMed

12.

Barnes G, Giri J, Courtney DM, Naydenov S, Wood T, Rosovsky R, Rosenfield K, Kabrhel C (1995) Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the National PERT™ Consortium members. Hosp Pract 2017(45):76–80

13.

[Recommendations of the Polish Gynecological Society expert panel on the use of Detramax in pregnancy]. Ginekol Pol 2015;86:962–5. PMID: 26995949

14.

Annabathula R, Dugan A, Bhalla V, Davis GA, Smyth SS, Gupta VA (2021) Value-based assessment of implementing a pulmonary embolism response team (PERT). J Thromb Thrombolysis 51:217–225CrossRefPubMedPubMedCentral

15.

Araszkiewicz A, Kurzyna M, Kopec G, Slawek-Szmyt S, Wrona K, Stepniewski J, Jankiewicz S, Pietrasik A, Machowski M, Darocha S, Mularek-Kubzdela T, Torbicki A, Pruszczyk P, Roik M (2021) Pulmonary embolism response team: a multidisciplinary approach to pulmonary embolism treatment. Polish PERT Ini Rep Kardiol Polska 79:1311–1319

16.

Carroll BJ, Beyer SE, Mehegan T, Dicks A, Pribish A, Locke A, Godishala A, Soriano K, Kanduri J, Sack K, Raber I, Wiest C, Balachandran I, Marcus M, Chu L, Hayes MM, Weinstein JL, Bauer KA, Secemsky EA, Pinto DS (2020) Changes in care for acute pulmonary embolism through a multidisciplinary pulmonary embolism response team. Am J Med 133:1313CrossRefPubMedPubMedCentral

17.

Chaudhury P, Gadre S, Schneider E, Renapurkar R, Gomes M, Haddadin I, Heresi G, Tong MZY, Bartholomew JR (2019) Impact of multidisciplinary pulmonary embolism response team availability on management and outcomes. Am J Cardiol 124:1465–1469CrossRefPubMed

18.

Deadmon EK, Giordano NJ, Rosenfield K, Rosovsky R, Parry BA, Al-Bawardy RF, Chang YC, Kabrhel C (2017) Comparison of emergency department patients to inpatients receiving a pulmonary embolism response team (PERT) activation. Acad Emerg Med 24:814–821CrossRefPubMed

19.

Finn MT, Gogia S, Ingrassia JJ, Cohen M, Madhavan MV, Nouri SN, Brailovsky Y, Masoumi A, Fried JA, Uriel N, Agerstrand CI, Eisenberger A, Einstein AJ, Brodie D, Rosenzweig EB, Leon MB, Takeda K, Pucillo A, Green P, Kirtane AJ, Parikh SA, Sethi SS (2021) Pulmonary embolism response team utilization during the COVID-19 pandemic. Vasc Med 26:426–433CrossRefPubMedPubMedCentral

20.

Groth CM, Acquisto NM, Wright C, Marinescu M, McNitt S, Goldenberg I and Cameron SJ Pharmacists as members of an interdisciplinary pulmonary embolism response team J Am Coll Clin Pharm. PMID: 35813573

21.

Jen WY, Kristanto W, Teo L, Phua J, Yip HS, MacLaren G, Teoh K, Sim TB, Loh J, Ong CC, Chee YL, Kojodjojo P (2020) Assessing the impact of a pulmonary embolism response team and treatment protocol on patients presenting with acute pulmonary embolism. Heart Lung Circul 29:345–353CrossRef

22.

Kabrhel C, Rosovsky R, Channick R, Jaff MR, Weinberg I, Sundt T, Dudzinski DM, Rodriguez-Lopez J, Parry BA, Harshbarger S, Chang YC, Rosenfield K (2016) 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 150:384–393CrossRefPubMed

23.

Khaing P, Paruchuri A, Eisenbrey JR, Merli GJ, Gonsalves CF, West FM, Awsare BK (1995) First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation. Hosp Pract 2020(48):23–28

24.

Kwok B, Brosnahan SB, Amoroso NE, Goldenberg RM, Heyman B, Horowitz JM, Jamin C, Sista AK, Smith DE, Yuriditsky E, Maldonado TS (2021) Pulmonary embolism response team activation during the COVID-19 pandemic in a New York city academic hospital: a retrospective cohort analysis. J Thromb Thrombolysis 51:330–338CrossRefPubMed

25.

Melamed R, St Hill CA, Engstrom BI, Tierney DM, Smith CS, Agboto VK, Weise BE, Eckman PM and Skeik N (2020) Effects of a consensus-based pulmonary embolism treatment algorithm and response team on treatment modality choices, outcomes, and complications Clin Appl Thromb-Hemost 26. PMID: 32539524

26.

Mortensen CS, Kramer A, Schultz JG, Giordano N, Zheng H, Andersen A, Nielsen-Kudsk JE and Kabrhel C Predicting factors for pulmonary embolism response team activation in a general pulmonary embolism population J Thromb Thrombolysis. PMID: 34370168

27.

Myc LA, Solanki JN, Barros AJ, Nuradin N, Nevulis MG, Earasi K, Richardson ED, Tsutsui SC, Enfield KB, Teman NR, Haskal ZJ, Mazimba S, Kennedy JLW, Mihalek AD, Sharma AM and Kadl A (2020) Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism Resp Res 21. PMID: 32571318

28.

Parikh M, Chahine NM, Hammad TA, Tefera L, Li J, Carman T, Schilz R, Shishehbor MH (2021) Predictors and potential advantages of PERT and advanced therapy use in acute pulmonary embolism. Catheter Cardiovasc Interv 97:1430–1437CrossRefPubMed

29.

Romano KR, Cory JM, Ronco JJ, Legiehn GM, Bone JN, Finlayson GN (2020) Vancouver general hospital pulmonary embolism response team (VGH PERT): initial three-year experience. Canadian J Anesth-J Canadien D Anesth 67:1806–1813CrossRef

30.

Rosovsky R, Chang YC, Rosenfield K, Channick R, Jaff MR, Weinberg I, Sundt T, Witkin A, Rodriguez-Lopez J, Parry BA, Harshbarger S, Hariharan P, Kabrhel C (2019) Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis (vol 47, pg 31, 2019). J Thromb Thrombolysis 47:41–41CrossRefPubMed

31.

Sista AK, Friedman OA, Dou E, Denvir B, Askin G, Stern J, Estes J, Salemi A, Winokur RS, Horowitz JM (2018) A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism. Vasc Med 23:65–71CrossRefPubMed

32.

Wiske CP, Shen C, Amoroso N, Brosnahan SB, Goldenberg R, Horowitz J, Jamin C, Sista AK, Smith D, Maldonado TS (2020) Evaluating time to treatment and in-hospital outcomes of pulmonary embolism response teams. J Vasc Surg-Venous Lymph Disord 8:717–724CrossRef

33.

Wright C, Goldenberg I, Schleede S, McNitt S, Gosev I, Elbadawi A, Pietropaoli A, Barrus B, Chen YL, Mazzillo J, Acquisto NM, Van Galen J, Hamer A, Marinescu M, Delehanty J, Cameron SJ (2021) Effect of a multidisciplinary pulmonary embolism response team on patient mortality. Am J Cardiol 161:102–107CrossRefPubMedPubMedCentral

34.

Xenos ES, Davis GA, He Q, Green A, Smyth SS (2019) The implementation of a pulmonary embolism response team in the management of intermediate- or high-risk pulmonary embolism. J Vasc Surg-Ven Lymph Disord 7:493–499CrossRef

35.

Kendall MR, Swadron S, Clavijo LC, Mehra AK, Hindoyan A, Matthews RV, Shavelle DM (2018) Us of the STEMI team for treatment of patients with pulmonary embolism: a pilot study. J Invas Cardiol 30:367–371

36.

37.

Hobohm L, Sagoschen I, Habertheuer A, Barco S, Valerio L, Wild J, Schmidt FP, Gori T, Munzel T, Konstantinides S and Keller K (2021) Clinical use and outcome of extracorporeal membrane oxygenation in patients with pulmonary embolism Resuscitation. PMID: 34653550

38.

Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM (2013) Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med 158:417–425CrossRefPubMedPubMedCentral

39.

Mahar JH, Haddadin I, Sadana D, Gadre A, Evans N, Hornacek D, Mahlay NF, Gomes M, Joseph D, Serhal M, Tong MZ, Bauer SR, Militello M, Silver B, Shishehbor M, Bartholomew JR, Heresi GA (2018) A pulmonary embolism response team (PERT) approach: initial experience from the Cleveland clinic. J Thromb Thrombolysis 46:186–192CrossRefPubMed

40.

Rivera-Lebron B, McDaniel M, Ahrar K, Alrifai A, Dudzinski DM, Fanola C, Blais D, Janicke D, Melamed R, Mohrien K, Rozycki E, Ross CB, Klein AJ, Rali P, Teman NR, Yarboro L, Ichinose E, Sharma AM, Bartos JA, Elder M, Keeling B, Palevsky H, Naydenov S, Sen P, Amoroso N, Rodriguez-Lopez JM, Davis GA, Rosovsky R, Rosenfield K, Kabrhel C, Horowitz J, Giri JS, Tapson V, Channick R, and Consortium P (2019) Diagnosis, treatment and follow up of acute pulmonary embolism: consensus practice from the PERT Consortium. Clin Appl Thromb Hemost 25:1076029619853037CrossRefPubMedPubMedCentral

41.

Schultz J, Giordano N, Zheng H, Parry BA, Barnes GD, Heresi GA, Jaber W, Wood T, Todoran T, Courtney DM, Naydenov S, Khandhar S, Green P and Kabrhel C (2019) EXPRESS: a multidisciplinary pulmonary embolism response team (PERT): experience from a national multicenter consortium Pulm Circ 2045894018824563. PMID: 30632901

42.

Barnes G, Giri J, Courtney DM, Naydenov S, Wood T, Rosovsky R, Rosenfield K, Kabrhel C, National PCRC (1995) Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the national PERT consortium members. Hosp Pract 2017(45):76–80

43.

Brailovsky Y, Lakhter V (2021) pulmonary embolism response team: additional call burden or a valuable learning opportunity? J Am Coll Cardiol 77:1691–1696CrossRefPubMed

44.

Lacey MJ, Hammad TA, Parikh M, Tefera L, Sharma P, Kahl R, Zemko A, Li J, Carman T, Schilz R, Shishehbor MH (2021) Prospective experience of pulmonary embolism management and outcomes. J Invasive Cardiol 33:E173–E180PubMed

45.

Sullivan AE, Holder T, Truong T, Green CL, Sofela O, Dahhan T, Granger CB, Jones WS and Patel MR (2020) Use of hospital resources in the care of patients with intermediate risk pulmonary embolism Eur Heart J Acute Cardiovasc Care. PMID: 33609111

46.

Hobohm L, Schmidt FP, Gori T, Schmidtmann I, Barco S, Munzel T, Lankeit M, Konstantinides SV, Keller K (2021) In-hospital outcomes of catheter-directed thrombolysis in patients with pulmonary embolism. Eur Heart J Acute Cardiovasc Care 10:258–264CrossRefPubMed

Title: Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis
Authors: Lukas Hobohm
Ioannis T. Farmakis
Karsten Keller
Barbara Scibior
Anna C. Mavromanoli
Ingo Sagoschen
Thomas Münzel
Ingo Ahrens
Stavros Konstantinides
Publication date: 17-08-2022
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 10/2023
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-022-02077-0

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Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Registration

Graphical abstract

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