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Critical Care Master Class - At the Edge of the Ev ...
Treatment of Patients with Submassive Pulmonary Em ...
Treatment of Patients with Submassive Pulmonary Embolism BURKART
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Pdf Summary
The document presents a discussion on the treatment and management of patients with submassive pulmonary embolism (PE) spearheaded by medical professionals from renowned institutions. Dr. Kristin M Burkart of Columbia University and fellow panelists delve into diagnostic criteria and various advanced therapeutic options such as systemic thrombolysis, catheter-directed therapies, and surgical embolectomy.<br /><br />Two case studies highlight real-world scenarios: <br /><br />1. The first involves a 59-year-old woman showing significant symptoms and evidence of a high-risk PE, treated eventually with catheter-directed thrombolysis (CDT) and VA-ECMO followed by surgical embolectomy. This case emphasizes the complex risk stratification and treatment decision pathways needed for patients with intermediate to high-risk PE, depending on presenting symptoms and response to initial treatments.<br /><br />2. The second case features a 39-year-old woman with a suspected high-risk PE but complications due to her medical history, including kidney impairment and recent surgeries. Her condition led to treatment with heparin and, upon later confirmation of PE, the multidisciplinary team decided on catheter-directed thrombolysis considering the risk factors and patient stability.<br /><br />Recent studies, including the PEITHO trial and others examining systemic thrombolysis and catheter-directed techniques, reveal ongoing debates and varied outcomes surrounding these therapies. The HI-PEITHO and FLAME studies highlight ongoing randomized trials aiming to define treatment efficacy better.<br /><br />While surgical interventions are typically reserved for the most severe cases, they aren't seen as just last-resort options anymore. Mechanical circulatory support (ECMO) might offer benefits when combined with surgical interventions. <br /><br />Ultimately, available local resources, institutional expertise, and patient characteristics shape the treatment pathways for high-risk PE, reflecting the need for individualized care strategies in managing such complex and critical conditions.
Keywords
submassive pulmonary embolism
systemic thrombolysis
catheter-directed therapies
surgical embolectomy
risk stratification
PEITHO trial
VA-ECMO
mechanical circulatory support
individualized care
treatment pathways
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