Institutional Logo Pulmonary Embolism Welcome Crisis and Opportunity

• Institutional Logo Pulmonary Embolism Welcome Crisis and Opportunity Kenneth Rosenfield, MD, MHCDS, MSCAI Massachusetts General Hospital …on behalf of the PERT Consortium. TM, a 501 c 3 organization

• Institutional Logo Thank you to our sponsors for their generous support… Platinum Janssen Pharmaceuticals A Division of Johnson and Johnson Gold EKOS- BTG

• Institutional Logo PERT: The Vehicle for Change! Why and how to get involved Kenneth Rosenfield, MD, MHCDS, MSCAI Massachusetts General Hospital …on behalf of the PERT Consortium. TM, a 501 c 3 organization

• Institutional Logo

• Institutional Logo HOW to get involved? …attend the annual PERT Business and CME Meetings in Nashville! June 21 PERT Business June 22 -23 CME

• Institutional Logo Pulmonary Embolism Response Team (PERT) Objectives • Respond expeditiously to treat patients with massive and submassive PE • Provide best therapeutic option(s) available for each patient • Leverage the input of a multidisciplinary team of experts • Coordinate care among services involved in management of PE • Develop protocols for the full range of therapies available • Collect data on clinical presentation, treatment efficacy, and outcomes (short and long -term) …Fill unmet clinical need and provide data to close gap in evidence base…

• Institutional Logo Pulmonary Embolism – previous paradigm …Chaos

Pulmonary Embolism – new paradigm • Institutional Logo ED / ICU / Floor Team/ Pulmonary Vascular Medicine/Cardiology Cardiac Surgery

• Institutional Logo Multidisciplinary Collaboration Pulmonary/ Critical Care Emergency Medicine Vascular Medicine and Intervention Hematology/ Oncology Cardiac Surgery PERT Cardiology/Echo Cardiac and Thoracic Imaging Interventional Radiology Nursing Vascular Surgery Quality & Safety

• Institutional Logo PERT Flow Map Expeditious input and clinical judgment from multiple specialties to optimize therapy ED MGH floor OSH PERT fellow: History Physical Labs EKG Echo CT-PE Low Risk Submassive Handoff to therapeutic site A/C Attending Lytic CDT Massive ACTIVATE PERT MULTIDISCIPLINARY TEAM Vortex Electronic Meeting Vascular Medicine Cardiac Surgery ICU/Pulmonary Hematology Rad, Echo ECMO Surgery

• Institutional Logo 3 rd Annual Meeting June 22, 2017 >175 member participants

• Institutional Logo What is a PERT? Bylaws. Definition “An institutionally based multidisciplinary team that: • has the ability to rapidly assess and provide treatment for patients with acute pulmonary embolism • has a formal mechanism to exercise a full range of medical, surgical, and endovascular therapies • can provide appropriate multidisciplinary follow-upof patients • when feasible, collects, evaluates and shares data regarding the effectiveness of treatment rendered”

• Institutional Logo PERT Consortium Organization

• Institutional Logo Membership 2017 • >70 Member Institutions (40 Founding) • 50+ “Transitional” Member Institutions • 500+ Professional Members • PERT International… • “PERT fever” spreading around the globe • “PERT champions” from China, Brazil, Uganda, Turkey, Canada, Netherlands, India

• Institutional Logo PERT Consortium - Boston, MA

• Institutional Logo PERT Consortium Activities • Full ownership of Annual Scientific PE • Developing standardized clinical Meeting practice protocols • Satellite symposia at national meetings • Webinars • “PERT-inent Updates” • On-line library of references for PE • Established governance structure • Election proceedings • Constituted Board of Directors • PAID MEMBER INSTITUTIONS: 40 FOUNDING. 60+ now; >100 involved • Multicenter registry with data-sharing • Corporate Committee of nearly 20 industry partners • Published manuscripts • Partner in clinical trials – PE TRACT

PERT Successes - • Institutional Logo • Coordinated care • Collaboration amongst experts; cross-disciplinary consensus; excitement about participation • Increased communication & better transitions • Single destination (MICU) • Involvement and buy-in of other specialties • Increased institutional awareness (grand rounds, etc. ) • More consistency in management • Appropriate decisions re: intervention and non-intervention • Development of algorithms & improved followup • Education of trainees

• Institutional Logo PERT Challenges and Opportunities • Obtaining institutional support • Demonstrating a change in outcome based on establishment of a PERT discussion • Not possible to randomize • Data collection “before and after”- different ascertainment BUT… • HUGE opportunity for collaboration across institutions with PERTs and large scale data collection and research initiatives

• Institutional Logo “The PERT Consortium is at the center of the PE universe, and is the most important opportunity to date for improvement in care and outcomes for patients with PE. ” -Michael Jaff

• Institutional Logo PERT: Future of PE Management • PE still poorly understood; much to learn…State of Art still yet to be defined • New era: heightened awareness about need for coordinated institutional approach to a complex, life-threatening problem • OPTIMAL CARE WITH TEAM APPROACH! • PERT: a “model” program of interdisciplinary collaboration to streamline care, optimize outcomes, and develop better treatment paradigms • PERTTM Consortium • fills important unmet need • power of team-based care and collaboration across institutions • opportunity to expand knowledge base, educate providers & community, increase awareness, improve clinical practice & outcomes for patients

• Institutional Logo JOIN NOW! THANK YOU!

Summary • PERT fills important unmet need • Institutional Logo • Consortium provides opportunity to expand knowledge base, educate providers & community, increase awareness, improve clinical practice & outcomes for patients • Registry will establish quality metrics, provide benchmarks, and enable evaluation of real world data and trends • Keys to success… • GREAT enthusiasm, passion, progress • collaborative spirit, inclusiveness, team-based approach to PERT, partnership with like-minded organizations & industry • PERT Consortium will create Guidelines and Establish Standard of Care for PE, and move the field forward