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PE Response Teams in the COVID Era

Written by Clay Smith

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Pulmonary embolism response teams (PERT) can be a big help in the diagnosis and treatment of acute PE in the COVID-19 era. Here’s how.

Why does this matter?
PERTs can help make evidence-based decisions in acute PE patients, but what should their role be in the midst of COVID-19? Several statements in this paper recommend early testing for COVID-19, an assumption the patient may be positive if unknown, and a default to taking safety precautions. I won’t repeat this in each step, as I assume you’ve got this. This will cover other recommendations.

Blood clots and COVID
This was a consensus statement on use of PERTs during COVID-19. Here are the high points and a handy PERT algorithm for the COVID era.

  1. Role of PERT: PERTs still have a role during COVID-19. A multidisciplinary team to diagnose and manage acute PE can positively impact care.

  2. Diagnosis of PE: Consider whether the extent of disease on imaging explains the degree of hemodynamic or gas-exchange abnormalities you’re seeing. If worse, a CTPA is probably worth doing. COVID-19 induces hypercoagulability; have a low threshold to workup PE. An elevated D-dimer alone may not necessarily indicate PE, as COVID-19 may cause this.

  3. Outpatient PE treatment during COVID-19: It is possible if patients meet criteria – low PESI, no RV dysfunction, etc. – but these patients need very close follow up. Bear in mind, they have a viral pneumonia and a PE.

  4. Thrombolysis: Use of thrombolysis is still an option and may be preferable to invasive intervention in some cases for staff safety.

  5. Transfer: Transfer for invasive intervention may still be an option but has to be on a case-by-case basis to weigh the risk vs. benefit. This is where a PERT is really helpful. If at a smaller facility, have the conversation early.

  6. Follow up: It is ideal for this to be virtual, but if they need a follow up on RV function, that may not be feasible.

  7. Safety: Reduce exposure of staff as much as possible, and leverage digital technology to assess imaging, vitals, monitoring, and other tasks whenever possible.

From cited article – PERT algorithm for the COVID-19 era

Source
Diagnosis and Treatment of Pulmonary Embolism During the COVID-19 Pandemic: A Position Paper from the National PERT Consortium. Chest. 2020 Aug 27:S0012-3692(20)34287-2. doi: 10.1016/j.chest.2020.08.2064. Online ahead of print.

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