The pulmonary embolism response team revolution: transforming PE management through multidisciplinary pathways

doi:10.15406/jaccoa.2025.17.00626

Journal of

eISSN: 2373-6437

Anesthesia & Critical Care: Open Access

Mini Review Volume 17 Issue 3

The pulmonary embolism response team revolution: transforming PE management through multidisciplinary pathways

Khaled Sewify,¹

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drsewafie@hotmail.com

Ahamd Elsayed,¹ Donia Elmasry,¹ Sara Alzahrani,¹ Sara Alghazal,¹ Zainab Alsenan,¹ Omar Alzuwayed,² Yousef Sewify,³ Nawal Algubaisi,⁴ Mohamed Shabaan,⁵ Sarwar Hussain,⁶ Turki Algarzaei,⁷ Hazem Amer,⁸ Khalid Al Faraidy⁸

¹Critical Care Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
²Pharmacy Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
³Airport Management, Sydney Kingsford Smith Airport, NSW, Australia
⁴Pulmonary Hypertension Department, KFMMC, Dhahran, Saudi Arabia
⁵ER Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
⁶CQI Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
⁷Respiratory Care Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
⁸Cardiology Department, KFMMC, Dhahran, Kingdom of Saudi Arabia

Correspondence: Khaled Sewify, Critical Care Department, KFMMC, Dhahran, Kingdom of Saudi Arabia

Received: July 07, 2025 | Published: July 21, 2025

Citation: Sewify K, Elsayed A, Elmasry D, et al. The pulmonary embolism response team revolution: transforming PE management through multidisciplinary pathways. J Anesth Crit Care Open Acces. 2025;17(2):91-4. DOI: 10.15406/jaccoa.2025.17.00626

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Abstract

Pulmonary embolism (PE) is a life-threatening cardiovascular emergency requiring rapid, coordinated, and multidisciplinary care. A Pulmonary Embolism Response Team (PERT) model provides a framework for evidence-based, timely diagnosis and treatment of PE. This article describes the development of a standardized clinical pathway supported by risk stratification tools, advanced imaging, and a collaborative team activation protocol. The PERT pathway enables streamlined, consistent, and safe management of acute PE, improving patient outcomes while ensuring optimal resource use.

Abbreviations: BMI,body mass index; BP, blood pressure; BNP, brain natriuretic peptide; CT, computed tomography; DVT, deep vein thrombosis; PE, pulmonary embolism. NOACs,New Oral Anticoagulants.

Introduction

Acute pulmonary embolism remains a leading cardiovascular emergency with significant morbidity and mortality worldwide. Its variable and often subtle clinical presentation may delay diagnosis, complicate management, and increase mortality rates.¹ Drawing inspiration from a structured multidisciplinary nutrition pathway previously implemented at our institution,² we developed standardized protocols supported by rapid multidisciplinary consultation are crucial to improve clinical outcomes in PE management. The Pulmonary Embolism Response Team (PERT) is a coordinated, interprofessional framework intended to accelerate care decisions, leverage risk stratification, and improve therapeutic interventions.³ By incorporating validated clinical tools, diagnostic algorithms, and structured communication processes, a PERT pathway offers a practical model to enhance the safety, timeliness, and quality of PE care.⁴

Pathway framework and screening protocol

A PERT-based pathway (as shown in Figure 1) begins with early clinical suspicion and initial diagnostic work-up, which includes:

12-lead electrocardiogram (ECG)
Troponin I
B-type natriuretic peptide (BNP)
D-dimer

Figure 1 Proposed Pulmonary Embolism Response Team (PERT) Clinical Pathway Flowchart.

Patients are then stratified using the Simplified Revised Geneva Score (Table 1).

Table 1 Simplified Revised Geneva Score: patient scoring 0 to 2 are low risk (or PE unlikely), and patient ≥ 3 are high risk (or PE likely). Adapted from¹

Ascore of:

0–2 points: low risk, PE unlikely
≥3 points: high risk, PE likely

For low-risk patients with negative D-dimer, PE is ruled out. In high-risk or positive D-dimer patients, advanced imaging is indicated with CT pulmonary angiography (CTPA) as first-line, and ventilation-perfusion (V/Q) scanning if CTPA is contraindicated.¹

Risk stratification and escalation

Following confirmation of PE, bleeding risk is evaluated using the HAS-BLED score (Table 4) to guide anticoagulation safety³. Prognostic risk is then categorized using:

Simplified PESI Score (Table 2) for short-term mortality.
BOVA Score (Table 3) for early deterioration risk.

Table 2 Simplified PESI Score: Adapted from Konstantinides et al.¹

Table 3 BOVA < 4: therapeutic anticoagulation will be initiated. Score ≥4 patient should be considered at high risk for a sub massive pulmonary embolus and prompt catheter directed thrombolysis initiated. Adapted from¹

Table 4 HAS BLED Score: A score of 0-2 indicates low risk of bleeding; a score more than 3 indicate high risk of bleeding. Hypertension is defined as a systolic blood pressure >160mmgh. 1 point is awarded for each of abnormal renal or liver function. And drugs or alcohol³

PERT activation is triggered for:

Massive PE (hemodynamic instability)
Intermediate-high risk PE (right ventricular dysfunction, elevated troponins, BOVA ≥4)
Diagnostic uncertainty requiring rapid multidisciplinary input

The designated PE responder coordinates a team conference including critical care, cardiology, radiology, and hematology specialists to determine treatment priorities.²

Team roles and advanced management

A typical PERT includes:

Critical Care Specialist (leads decision-making).
Cardiologist (supports risk stratification and cardiac echo).
Interventional Cardiologist (coordinates intervention and share in decision making).
Pulmonologist (share in decision making).
Specialized PE nurse (first responder, risk stratification and coordinates patient monitoring).

Depending on severity, the therapeutic plan may include:

Low-risk PE: anticoagulation, possible early discharge on new oral anticoagulation (NOACs).
Massive PE: systemic thrombolysis (10 mg bolus + 90 mg over 2 hours or weight-adjusted).
Intermediate-high risk PE (BOVA ≥4): catheter-directed thrombolysis or catheter aspiration.
Super-refractory PE: escalation to veno-arterial ECMO and/or surgical embolectomy.

Discussion

A structured Pulmonary Embolism Response Team pathway offers a pragmatic, multidisciplinary, and evidence-based model for managing acute PE. The inclusion of risk stratification scores (Geneva, PESI, BOVA), bleeding assessment (HAS-BLED), and team activation criteria improves both consistency and timeliness of PE management (1–3). By clarifying responsibilities across a multidisciplinary team and embedding decision support tools, the PERT pathway promotes standardized care and reduces variability in critical interventions. Such models have been shown to improve time to treatment, reduce complications, and potentially improve mortality.²

Clinical implications and outcomes

The PERT model supports best practices aligned with international guidelines and may serve as a benchmark for hospitals aiming to standardize PE management (1,2). Incorporating validated risk assessment, clear treatment escalation pathways, and structured team communication ensures improved coordination and patient-centered care delivery. The PERT pathway can also enhance audit readiness, promote guideline compliance, and support future quality improvement initiatives.

Conclusion

The multidisciplinary PERT framework described in this article demonstrates a reproducible, safe, and effective method for managing acute pulmonary embolism. Combining validated scoring tools, advanced imaging, and team-based rapid consultation supports timely and optimal PE treatment. Hospitals implementing this model can achieve better patient outcomes and strengthen quality of care.

Acknowledgments

The authors acknowledge the support of colleagues across critical care, cardiology, hematology, and radiology services who helped develop the pathway.