Samuel Z. Goldhaber, MD

Disclosures

December 21, 2016

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Hello. This is Dr Sam Goldhaber from Brigham and Women's Hospital and Harvard Medical School, in Boston, Massachusetts, speaking for the Clot Blog at theheart.org on Medscape. I am speaking from the European Society of Cardiology meeting in Rome, Italy.

Today, I am going to focus on pulmonary embolism response teams (PERTs). These are multidisciplinary teams that include cardiologists, vascular medicine specialists, hematologists, pulmonologists, cardiac surgeons, interventional radiologists, and interventional cardiologists. These teams converge when patients are identified in the emergency department or are already hospitalized with a massive or submassive pulmonary embolism.

The Massachusetts General Hospital in Boston has one of these teams, which just published its 30-month experience with more than 300 such patients.[1] One of the important features of these PERTs is that they help specialists in the hospital to work together and coordinate management strategies from many different perspectives. They also evaluate the patients as a team rather than the patient seeing one specialist after the next, which cuts down on such problems as sending mixed messages to the patient, the family, and the primary care team. The PERT will issue a uniform recommendation that has been achieved by consensus.

One very interesting aspect is that no PERT service has a single, specific protocol for massive or submassive pulmonary embolism that is enforced in a strict manner. I believe this kind of team is especially useful now that we have new tools, such as extracorporeal membrane oxygenation (ECMO), for patients with massive pulmonary embolism. With ECMO, time really does matter, and the sooner it is applied, the better.

The PERT focuses on what we can do for patients with massive or submassive pulmonary embolism. We have many choices: ECMO for the sickest of the sick patients; open surgical pulmonary embolectomy; systemic thrombolysis; catheter-directed thrombolysis; pharmacomechanical therapy, particularly with ultrasound-assisted catheter-directed thrombolysis; insertion of an inferior vena caval filter; and full-dose anticoagulation. In many respects, this treatment does take a village, because there are so many different directions one can go.

On the basis of these new data from Massachusetts General Hospital, we believe that PERTs are opening up the discussion about the advanced tools that are available. More than 20% of the patients with massive pulmonary embolism in this series[1] underwent advanced therapies, such as thrombolysis or pulmonary embolectomy.

I believe the PERTs are spreading not only throughout the United States but also internationally. The next PERT Symposium will be held in Boston, Massachusetts, in June 2017. These meetings are growing larger and attracting more attention year after year, bringing pulmonary embolism to the forefront of discussion. Most valuable is that they bring together specialists from different disciplines for great academic and practical exchanges, bringing further progress to the field.

This is Dr Sam Goldhaber, signing off for the Clot Blog.

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