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URMC / Quality & Safety / PERT


PERT Announcement

Starting November 1 2016, Strong Memorial Hospital will have a Pulmonary Embolism Response Team (PERT).  PERT will immediately assess and help to stabilize and guide treatment in patients with high and intermediate risk pulmonary embolism (please refer to important activation criteria).

PERT teams are gaining a national presence across the U.S. in an attempt to standardize treatment and disposition of patients with high risk (massive) and intermediate risk (submassive) pulmonary embolism.  High and intermediate risk pulmonary embolism constitute a thrombotic emergency, with national registries showing a 90-day mortality of 25-60%.  

Managing critically ill patients with massive and submassive pulmonary embolism is highly dependent on the clinical scenario and requires careful consideration of cardiovascular and pulmonary mechanics, and sometimes requires swift mobilization of procedural teams to initiate ECMO, catheter-directed thrombolysis, and surgical thrombectomy where appropriate.  The UR PERT is comprised of the following disciplines: cardiology, pulmonary medicine, cardiothoracic surgery, vascular surgery, and emergency medicine.

The Cardiac Care Unit will perform the initial assessment and streamline patient disposition for a PERT activation in the Emergency Department, involving other specialties immediately if required.  For patients already admitted to Strong Memorial Hospital on an inpatient service, PERT will be available for consultation and to guide treatment if needed.  If you have a patient meeting the criteria for high risk or intermediate risk pulmonary embolism, please call x52222 and request the “Pulmonary Embolism Response Team”, providing the patient name, MRN, and location to the paging office.

PERT Activation Criteria
Call: x52222 and ask for the “Pulmonary Embolism Response team”.

Massive PE
1. DVT or PE by imaging.
2. SBP < 90 mmHg for >10 minutes, or pressor/inotrope-dependence.
3. Hypotension due to another medical issue excluded.

Submassive PE
1. DVT or PE by imaging.
2. Right heart strain (CT imaging or echocardiography) OR cardiac TnT > 0.01 ng/mL and/or NT-proBNP > 500 pg/mL.

* If the above criteria are met, the PERT pager should be activated.
** PERT pager should NOT be activated for low risk PE (segmental, sub-segmental PE, normal hemodynamics, no evidence of right heart strain).