CME 30/04/15 - Management options in massive and submassive pulmonary embolism

Management options in massive and submassive pulmonary embolus from SCGH ED CME

Here is Tom’s talk on the management options in massive and submassive pulmonary embolism. Due to the heterogeneity of these patients, the range of treatment options / treating sub-specialties and the lack of studies directly comparing treatment options in patient subgroups. Currently, there is no well defined management protocol in this patient group. However, a working group, including the relevant sub-specialties, is being formed at SCGH to hopefully clarify the most appropriate management options in subgroups of these patients at this hospital, based on the currently available evidence. I will keep you posted on the outcome. Until then, here is some light reading on the topic…

Resources:

Thrombolysis:
- A good summary of the evidence for “Thrombolysis for submassive pulmonary embolus” from Chris Nickson of LITFL – revised in 7/2014 including links to relevant studies
- A relatively current meta-analysis on this topic: Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Hemorrhage – A Meta-analysis. Chatterjee et al. JAMA. 2014;311(23):2414-2421
  - Here is The Bottom Line’s summary of this meta-analysis

Surgical Pulmonary Embolectomy
- Surgical Pulmonary Embolectomy The Resurrection of an Almost Discarded Operation. Samuel Z. Goldhaber, MD. Tex Heart Inst J. 2013; 40(1): 5–8
- Modern surgical treatment of massive pulmonary embolism: Results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach. Leacche et al. J Thorac Cardiovasc Surg. 2005 May;129(5):1018-23.

Catheter-Directed Thrombolysis
- Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT): Initial Results from a Prospective Multicenter Registry. Kuo et al. Chest. 2015. doi:10.1378/chest.15-0119

Great lecture by Oren Friedman (Pulmonary and Critical Care Physician) from the 2015 EMCrit Conference on Hemodynamic Management of Massive Pulmonary Embolism (PE) from EMCrit