The role of the PERT team in 2021

Abstract

Pulmonary embolism (PE) is a major cause of morbidity and mortality worldwide. In the United States alone, it is estimated that up to 100,000 PE-related deaths occur each year. While anticoagulant therapy is highly effective in reducing the risk of mortality in the majority of patients, advanced therapeutics are required in certain high-risk scenarios, such as in the setting of massive PE with haemodynamic compromise where urgent reperfusion therapy is strongly recommended. Conversely, patients with low-risk PE can often be safely managed with anticoagulant therapy alone and without the requirement of advanced therapies or for hospital admission. The optimal approach to management is less clear among patients with intermediate risk PE. In this setting, there is limited data to guide decision-making regarding the role of more aggressive treatment strategies and the competing risks are significant. The Pulmonary Embolism Response Team (PERT) model of care was developed in 2012 in order to support rapid clinical decision-making in the setting of complex acute PE. The PERT draws on expertise across multiple disciplines and provides a framework for timely access to advanced therapeutics when indicated based on consensus decision. The PERT model of PE care has expanded internationally and has led to operational streamlining in PE management through enhanced communication. Registry data suggest that the introduction of the PERT system is associated with an increased use of advanced techniques, such as catheter-directed thrombolysis without a concomitant increase in bleeding complications, although data from randomized trials are lacking. International guidelines have supported the concept of formalizing pathways of engagement between multidisciplinary colleagues. In the absence of randomised trial data, the model of care provided by PERT appears to represent the most effective means of optimizing communication strategies between specialist colleagues to collaborate in the care of individual patients, particularly in scenarios where patients present with complex care needs and where the balance of risks may be difficult to determine.