PERT is an interdisciplinary effort to provide rapid assessment and treatment based upon the patient’s condition and best practice guidelines. Research has shown that a systematic approach to treating pulmonary embolism (PE) patients will increase time to treatment and decrease adverse events including mortality and long term heart failure.
A PERT ALERT is initiated on all patients diagnosed with a Sub-Massive or Massive PE to establish a mechanism for key personnel to rapidly evaluate and accurately risk stratify to provide evidence-based care and treatment. Patients are risk stratified in to 3 categories: Low Risk, Sub-Massive, or Massive. Potential patients appropriate for Catheter Based Treatment (CBT) are those stratified as Sub-Massive and Massive. Most patients qualify for Catheter Based Treatment. The goal of CBT is the removal of the obstructing thrombi from the pulmonary arteries to facilitate right ventricular recovery, and to improve symptoms and survival. This includes reduction of long term heart failure. CBT uses significantly less tPA than medical treatment (or systemic treatment), thus reducing bleeding complications. Few patients receive Surgical Pulmonary Embolectomy. By providing a systematic evidence based approach, we may be able to get patients to surgery before they decompensate to a point of no return.
The initial key person to contact is the Interventional Cardiologist on call for PERT ALERT. Additional persons can include pulmonologist, surgeon, hospitalist, hematologists and pharmacist. Nursing provides support by closely monitoring the patient’s condition for deterioration, ensuring rapid completion of tests such as Stat CT Scan, Stat Echo, EKG and lab work, and administering medications.
PERT Alerts should be called by the physician receiving the report of a confirmed PE. Once a PERT Alert has been activated a PERT Alert Algorithm will be followed as indicated in the PERT Alert Policy, #9856-261. The PERT Alert Policy went into effect system wide effective May 1st, 2018. The interventional cardiologist on call for PERT Alert can be found via the ED Call schedules.