Pulmonary Embolization Interventions & Response Teams
with Dr. Eric Secemsky and Dr. Sabeen Dhand
BackTable, LLC (Producer). (2021, April 12). Ep. 120 – Pulmonary Embolization Interventions & Response Teams [Audio podcast]. Retrieved from https://www.backtable.com/podcasts
Interventional Radiologist Sabeen Dhand talks with Interventional Cardiologist Eric Secemsky about building a Pulmonary Embolism (PE) Response Team, and about the various techniques for treatment of PE used in his practice.
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Dr. Eric Secemsky
Dr. Eric A. Secemsky, MD, MSc, RPVI, FACC, FSCAI, FSVM is the Director of Vascular Intervention and an Interventional Cardiologist within the CardioVascular Institute at Beth Israel Deaconess Medical Center (BIDMC).
Dr. Sabeen Dhand
Host Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.
In this episode, interventional cardiologist Dr. Eric Secemsky and our host Dr. Sabeen Dhand discuss pulmonary embolization and the coordination of Pulmonary Embolism Response Teams (PERTs).
Dr. Secemsky starts by introducing the diagnosis of pulmonary embolisms. He explains the classification of patients into the categories of massive, submassive, and low-risk embolisms, as well as echocardiogram and CT imaging. His workup includes not only checking for clot burden, but also checking for vital sign abnormalities, evidence of right ventricle dysfunction, and neurological deficits.
Then, we transition to talking about the structure, workflow, and communication technologies used in pulmonary embolism response teams. Dr. Secemsky describes his experience with building a response team and ensuring its adaptability for a variety of cases. He emphasizes the importance of multidisciplinary care and team members’ accountability for every patient.
Finally, we discuss treatment of pulmonary embolism, based on how emergent a case is. Dr. Secemsky describes factors to consider when employing different treatments: clot extraction devices, thrombolytics, and anticoagulants. Additionally, we cover the topics of catheter-directed thrombolysis, mechanical thrombectomy, and surgical embolectomy.
Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association- https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000707
AHA guidelines for the classification of massive, submassive, and low-risk pulmonary embolisms.
PERT Consortium- https://pertconsortium.org/
Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714903/
SUNSET sPE study- https://vivaphysicians.org/news-article?id=88424
[Dr. Sabeen Dhand]
You mentioned PERT. I mean, you were part of the developing team of PERT at your hospital. Can you just go into how a PE response team functions at your hospital?
[Dr. Eric Secemsky]
Before I got to Mass General for my fellowship, I was at UCSF and it was interesting because we had no advanced therapies available. A PE came in and we anticoagulated them and, occasionally, you would get one that was incredibly sick or had a lot of clot burden and we would actually ambulance them. You couldn’t even fly them down to San Diego. They had a big thromboembolic program there and they'd either get a surgical embolectomy or some other advanced treatment.
So, now, it's 2021 and most hospitals can manage all flavors of PE now. When this was starting at our hospital at Mass General, I was a little bit on the cursory. Like I said, I was primarily manning the echo probe. But, Ken Rosenfield, Rick Channick, Rachel Rosovsky, Chris Kabrhel, really a multidisciplinary group of people, came together and said no one is owning this condition, yet it's incredibly morbid and fatal. These patients come to the hospital and no one knows what is the right decision. At the same time, more and more therapies are becoming available. So, why don't we approach this in a multidisciplinary way to make our best clinically-informed decisions, with whatever evidence is available, to help manage these patients?
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