Tyler L Bloomer1, Eric J Thomassee, Pete P Fong. 1. From the Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Abstract
BACKGROUND: The ideal treatment strategy for acute pulmonary embolism (PE) remains a subject of debate. Treatment strategies vary based on numerous factors including the clinical scenario, hemodynamic variables, PE location, and personnel who are trained in advanced PE management therapies. METHODS: Similar to an acute myocardial infarction network, we created a regional referral system called the Acute PE Network to facilitate the transport of patients with PE from referring facilities and improve access to advanced therapies. Simultaneously, we created a multidisciplinary PE response team (PERT), developed diagnostic protocols, and created a therapeutic pathway that includes the use of ultrasound-assisted catheter-directed thrombolysis (USAT) for submassive PE. Data were collected on patient characteristics, echocardiographic findings, and clinical outcomes for patients treated with USAT utilizing this pathway. RESULTS: From January 2012 to May 2014, 31 patients who were treated with USAT for acute PE were identified. Fourteen of these patients were transferred through our Acute PE Network, whereas 17 patients presented directly to the emergency department. All patients were consulted upon by our PERT. Among those patients who had both pre-USAT and post-USAT echocardiograms performed for comparison (n = 19), right ventricular function improved or was preserved in 94% of patients, and right ventricular size improved or was preserved in 88% of patients. CONCLUSIONS: Through the development of an Acute PE Network, with incorporation of a PERT and implementation of a critical care pathway, we report an innovative treatment approach to acute PE that includes utilization of USAT for submassive PE.
BACKGROUND: The ideal treatment strategy for acute pulmonary embolism (PE) remains a subject of debate. Treatment strategies vary based on numerous factors including the clinical scenario, hemodynamic variables, PE location, and personnel who are trained in advanced PE management therapies. METHODS: Similar to an acute myocardial infarction network, we created a regional referral system called the Acute PE Network to facilitate the transport of patients with PE from referring facilities and improve access to advanced therapies. Simultaneously, we created a multidisciplinary PE response team (PERT), developed diagnostic protocols, and created a therapeutic pathway that includes the use of ultrasound-assisted catheter-directed thrombolysis (USAT) for submassive PE. Data were collected on patient characteristics, echocardiographic findings, and clinical outcomes for patients treated with USAT utilizing this pathway. RESULTS: From January 2012 to May 2014, 31 patients who were treated with USAT for acute PE were identified. Fourteen of these patients were transferred through our Acute PE Network, whereas 17 patients presented directly to the emergency department. All patients were consulted upon by our PERT. Among those patients who had both pre-USAT and post-USAT echocardiograms performed for comparison (n = 19), right ventricular function improved or was preserved in 94% of patients, and right ventricular size improved or was preserved in 88% of patients. CONCLUSIONS: Through the development of an Acute PE Network, with incorporation of a PERT and implementation of a critical care pathway, we report an innovative treatment approach to acute PE that includes utilization of USAT for submassive PE.
Authors: Stephen J Huang; Marek Nalos; Louise Smith; Arvind Rajamani; Anthony S McLean Journal: Intensive Care Med Date: 2018-05-22 Impact factor: 17.440
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