Rationale for and approach to establishing a multidisciplinary acute pulmonary embolism expert care team

Patients with acute pulmonary embolism (PE) may present with cardiac arrest, overt or impending cardiogenic shock and/or severe respiratory insufficiency. Immediate evaluation and management of these patients require high clinical suspicion along with (bedside) imaging to confirm the diagnosis, targeted haemodynamic and/or respiratory support, appropriate anticoagulant treatment, and in many cases reperfusion therapy. The immediate treatment decision-making is largely driven by local expertise and resources and should be guided by the individual patient's characteristics such as cardiopulmonary comorbidities, risk of bleeding and location, extent and haemodynamic impact of the clot. Over the past years, treatment options for patients with severe PE have expanded substantially. For instance, several new catheter-guided reperfusion therapies have emerged and experience with circulatory mechanical support has increased. Along with the rise of new interventional therapies has come the introduction of expert multidisciplinary pulmonary embolism (EXPERT-PE) care teams, composed of multidisciplinary specialists involved in treating severe acute PE. This model of care provides a platform for rapid decisions on individualized treatment strategies, combining expert opinion from all involved specialties, setting the quality standards for modern local and regional equity PE care, and forming the base for future research in this area. Clinical decisions should be evidence-based where possible, and incorporate the individual patient's and their carer's preferences, values, and priorities, as well as those of the managing clinicians and care team. In this review, we summarize the evidence for the introduction of EXPERT-PE care teams and provide a practical manual for their successful implementation.