March 22, 2019 by John Fernandez
‘Response Teams’ for Pulmonary Embolisms are Saving More Lives
Imagine a medical “SWAT team” that mobilizes to help patients with a particular condition that can be life-threatening.
That’s essentially the function of a Pulmonary Embolism Response Team, or PERT, a group of multidisciplinary experts who come together to establish optimal treatment for patients with high-risk forms of pulmonary embolism (PE). Miami Cardiac & Vascular Institute has taken a leading role locally and nationally in PERTs that treat either a massive or sub-massive PE, the most serious forms of the condition.
A PE is a sudden blockage in a lung artery. The condition usually happens when a when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause death or damage to other organs in the body from not getting enough oxygen. Moreover, there are a range of treatments that may not suit certain patients, which is why PERTs have been instituted in several dozen hospitals and healthcare systems nationwide.
PE is the third most common cause of death from cardiovascular disease, just after heart attack and stroke. And it’s thought to be the third-leading cause of death in hospitals.
The strategy of having a team of multidisciplinary collaborators within a hospital or healthcare system to treat complex medical conditions is not a new concept. But having such a group of experts at the ready to tackle individual cases of a potentially life-threatening PE is a strategy that has become reality just this decade, and now includes a growing national consortium of PERTs.
Response Teams Help Advance PE Treatments
The work of PERTs has helped advance treatment therapies and saved more patient lives, explains James Benenati, M.D., an interventional radiologist and medical director of the Noninvasive Vascular Laboratory at Miami Cardiac & Vascular Institute.
Dr. Benenati and the PERT at the Institute, part of Baptist Health South Florida, is an example of collaboration that is improving outcomes for patients and expanding the knowledge base of a condition that is increasing in its diagnoses, especially as Baby Boomers, accounting for nearly a quarter of the U.S. population, and other vulnerable groups, such as cancer patients, are increasingly at risk for PE complications.
The Institute is part of the national PERT consortium. Additionally, there are now more medications that present risk factors to PE patients, which fuels the need for more input from PERTs, says Dr. Benenati.
Sub-massive PE cases may not be as life-threatening, but they can progress to become massive. “In the hospital, depending on patient’s risk factors, the death rate is somewhere between 5 and 15 percent of those patients with sub-massive PE,” explains Dr. Benenati. “For those with massive PE, the death rate can be 30 percent or more.”
Cases of pulmonary embolism often go unrecognized, he adds.
Taking Advantage of Multiple Specialties
“And even when it’s recognized, there are so many schools of thought about treatment, and not all patients get treated the same way,” said Dr. Benenati. “So, the idea is to take advantage of everybody’s expertise and use multiple specialties, such as interventional radiology, vascular medicine, cardiology, pulmonary medicine, critical care medicine and cardiothoracic surgery, and put all the minds together. And we know this works in other areas in medicine. We have data that shows outcomes are better when we get other specialties involved.”
There is a growing range of procedures to treat PE which carry different degrees of risk, he says.
“But when we work as a team, it’s much easier to do these procedures because everyone is on the same page,” adds Dr. Benenati. “Instead of just the standard anti-coagulants, we have catheter-directed thrombolysis, which is something we’ve been doing. More recently, there is mechanical thrombectomy, which is something we’ve been doing quite a bit at Baptist Health. We’re part of a national trial for that right now. This procedure is for patients who can’t receive tPA medication, or thrombolytics. We now have treatment options for those patients.”
Improving treatments and widening the scope of therapies is convincing more hospitals and healthcare systems to adopt PERTs.
“The real important thing is that the teamwork from a PERT can lead to advanced therapies,” says Dr. Benenati. “A lot of what we know about pulmonary embolisms is really in its infancy stage. There is so much left to learn. So by putting this on a national level, we can really accelerate this field and, ultimately, save a lot more lives.”