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Published on February 13, 2018

Activate PERT for prompt treatment of pulmonary embolism

Ezana Azene, MD, PhD

Ezana Azene, MD, PhD

When a patient presents with a heart attack, you consult a cardiologist. When a patient presents with a stroke, you consult a neurologist. When a patient presents with a life-threatening pulmonary embolism (PE)—the number one cause of inpatient mortality—the answer is not as clear.

Gundersen Health System is changing that. We've developed a Pulmonary Embolism Response Team (PERT), a paradigm that was first created by a team of physicians at Massachusetts General Hospital in 2012.

"The PERT uses a multidisciplinary rapid-response team model to help care for patients with massive and sub-massive PE using institutionally accepted algorithms based on the most recent national guidelines and research," explains Gundersen interventional radiologist Ezana Azene, MD, PhD.

In January 2017, Gundersen became an inaugural member of the National PERT Consortium—a group dedicated to advancing PE care and promoting research in the treatment of PE. Now more than 100 centers strong, the PERT Consortium also maintains a PERT Registry which allows Gundersen to compare performance/outcomes with other institutions over time and participate in large, multi-center clinical trials.

PERT is not for all patients with PE, only those who meet criteria of massive or sub-massive PE, including:

  • PE with systolic BP <90 mmHg or systolic BP drop ≥ 40 mmHg
  • PE with new acute kidney injury, altered mental status or other signs of end-organ hypoperfusion
  • PE with right heart strain (Echo, EKG, CTA, troponin, BNP)
  • Large-volume PE

Activating PERT at Gundersen is simple:

  1. Call MedLink at (608) 775-5465 or (800) 336-5465.
  2. Ask to have the Pulmonary Embolism Response Team (PERT) activated.
  3. Order the following, if you have not already done so:
    • EKG, CXR
    • CBC, INR, aPTT, Creatinine
    • Troponin, NT-proBNP, lactate

Once activated, PERT uses a multidisciplinary team approach—including a referring provider, interventional radiologist and critical care physician—to discuss the case, make acute treatment recommendations, coordinate care and arrange post-discharge follow-up.

While rapid, acute treatment is very important, Dr. Azene says it's just one of the necessary pieces of the PE puzzle.

"Long term, the most important factor is making sure that providers are appropriately risk stratifying and diagnosing patients with PE because it's missed a lot. Very commonly, it's mistaken for pneumonia or heart attack. We know that a delayed PE diagnosis increases the risk of death tenfold.

"What makes the PERT model so valuable is the way it coordinates PE care across the entire course of the disease—from diagnosis to acute treatment to post-acute follow-up," explains Dr. Azene.

As such, Gundersen PERT has developed an Acute PE Diagnostic Algorithm to help primary care providers appropriately apply outpatient risk-stratification tools, make wise and efficient use of medical imaging, and stratify patients with PE into high-risk and low-risk groups.

In addition, Gundersen now has a PERT Clinic—run through the Pulmonary Outpatient Clinic—which follows patients with massive and sub-massive PE for two years after diagnosis. This extended follow-up is used to monitor for chronic conditions of PE, such as chronic thromboembolic pulmonary hypertension (CTEPH).

To activate PERT at Gundersen or to contact Dr. Azene with a question, call MedLink at (608) 775-5465 or (800) 336-5465.

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