anticoagulation must be given without delay unless contraindicated

https://pertconsortium.org/  PERT Consortium Website with excellent webinars and educational podcasts by a panel of European and US experts

https://websites.godaddy.com/en-CA/editor/3d6b1218-5d64-44f3-b76c-5db43f5ece91/46da1165-298a-41d8-8aaf-e4e45924efd6/preview  (Excellent overall review of the topic)​

Myc, L.A., Solanki, J.N., Barros, A.J. et al. Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism. Respir Res 21, 159 (2020). https://doi.org/10.1186/s12931-020-01422-z. (This is the PERT team article with outcomes)​

The PERT ConceptA Step-by-Step Approach to Managing Pulmonary EmbolismBelinda N. Rivera-Lebron, MD; Parth M. Rali, MD; and Victor F. Tapson, MD CHEST 2021; 159(1):347-355 https://pubmed.ncbi.nlm.nih.gov/32758561/  (Just a good paper about how to start up a response team)​

Meyer G et al, for the PEITHO investigators (PEITHO-1). NEJM 2014:370:1402-11. https://www.nejm.org/doi/full/10.1056/nejmoa1302097 (This is the thrombolytics + anticoagulation versus anticoagulation alone trial for submassive PE) ​

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC).  Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N,Áinle FN, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL, The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC).  Eur Respir J. 2019;54(3) Epub 2019 Oct  https://academic.oup.com/eurheartj/article/41/4/543/5556136 (These are the European Society Guidelines where the definitions of high risk and intermediate high-risk PE are defined) ​

Romano KR, Cory JM, Ronco JJ, Legiehn GM, Bone JN, Finlayson GN. Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience. Can J Anaesth. 2020 Dec;67(12):1806-1813. English. doi: 10.1007/s12630-020-01790-6. Epub 2020 Aug 17. PMID: 32808096. https://pubmed.ncbi.nlm.nih.gov/32808096/ (This is the VG Experience)​

Kucher et al, Circulation 2014:129:479-486  Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism

Ismayl et al. Meta-Analysis Comparing Catheter-Directed Thrombolysis Versus Systemic Anticoagulation Alone for Submassive Pulmonary Embolism. https://www.ajconline.org/article/S0002-9149(22)00632-4/fulltext

Klok et al  Ultrasound-facilitated, catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: Rationale and design of the HI-PEITHO study. https://pubmed.ncbi.nlm.nih.gov/35588898/

Sanchez et al. Reduced-Dose Intravenous Thrombolysis for Acute Intermediate–High-risk Pulmonary Embolism: Rationale and Design of the Pulmonary Embolism International THrOmbolysis (PEITHO)-3 trial. https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-1653-4699.pdf

Jiménez D, Aujesky D, Moores L, et al. Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism. Arch Intern Med. 2010;170(15):1383–1389. doi:10.1001/archinternmed.2010.199 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/775646 (Article on sPESI score)​

Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013 Apr;84(4):465-70. doi: 10.1016/j.resuscitation.2012.12.016. Epub 2013 Jan 4. PMID: 23295778. https://pubmed.ncbi.nlm.nih.gov/23295778/  (Article about NEWS scores)

Parham Sadeghipour, MD1,2; Yaser Jenab, MD3; Jamal Moosavi, MD1; et al  Catheter-Directed Thrombolysis vs Anticoagulation in Patients With Acute Intermediate-High–risk Pulmonary Embolism The CANARY Randomized Clinical Trial. JAMA Cardiol. 2022;7(12):1189-1197. doi:10.1001/jamacardio.2022.3591

David Planer, Stav Yanko, Ilan Matok, Ora Paltiel, Rama Zmiro, Victoria Rotshild, Offer Amir, Gabby Elbaz-Greener and Bruria Hirsh Raccah  Catheter-directed thrombolysis compared with systemic thrombolysis and anticoagulation in patients with intermediate- or high-risk pulmonary embolism: systematic review and network meta-analysis. CMAJ June 19, 2023 195 (24) E833-E843; DOI: https://doi.org/10.1503/cmaj.220960