P373 IN SUPPORT OF THE NEED FOR P.E.R.T. (PULMONARY EMBOLISM RESPONSE TEAMS) IN PULMONARY EMBOLISM (PE)

Abstract

Abstract Pulmonary embolism (PE) is one of the leading causes of cardiovascular death with a wide range of criticality and complex and varied pathogenesis. A rapid therapeutic decision reverses the rapid progression towards a fatal outcome. A 64 years old patient, obese and hypertensive, returning from an intercontinental flight, went to the emergency room because of worsening dyspnoea and chest pain, which he had been suffering for a week; he arrived tachycardic, tachypnoic and with 91% O2 saturation in ambient air. A CT angiography showed extensive thrombosis of both main branches of the pulmonary artery (PA). Echocardiography confirmed right ventricular involvement, which was already hypokinetic and with a RV/LV ratio double than normal, which corresponds to a progressive drop in pressure and for which he was transferred to the cardiac intensive unit. The patient‘s history, comorbidities, risk of haemorrhage, imaging and laboratory data were analysed, leading to an evaluation of high risk PE, hemodynamic instability and positive cardiac biomarkers. With the availability of on–site equipment and trained personnel, the patient underwent ultrasound–guided locoregional thrombolysis through the placement of dedicated catheters capable of infusing into each PA branch 1mg of rtPA/h for 12 hours and ultrasound throughout the course of the catheter to increase the penetrance of thrombolysis into old thrombi (Ultrasound Accelerated Thrombolysis). As early as 6 hours, at echocardiographic control, there was a reduction in the RV/LV ratio to below 1.5, corresponding to a restoration of pressor stability. PERT shortens the time of decision of the best medical approach, which is the most effective method available to deal with the emergency. But PERT is also useful in low–risk PE in patients with significant comorbidities that contraindicate anticoagulant therapy, or in PE that is an incidentalomas, according to the wisdom of the radiologists in the group who know how to identify inveterate thromboses or PA sarcoma occlusion which are otherwise treatable. Hence the need for a multidisciplinary team: a) able to assess the patient with PE and provide the correct treatment which includes a range of medical, surgical and endovascular therapies; b) skilled in ensuring the follow–up of the patient with PE (post–thromboembolic pulmonary hypertension; c) skilled in getting the components to communicate about the effectiveness of treatment in the individual patient.