Dr. Rich Channick, an intensivist at UCLA specializing in pulmonary vascular disease, shares his expert insights on managing pulmonary embolism. He discusses the intricacies of risk stratification and the importance of tailor-made treatment strategies. The conversation dives into advanced interventions like catheter-directed therapies and the role of Pulmonary Embolism Response Teams. With a focus on clinical decision-making, the episode also highlights the latest advances in thrombolytic therapy and ongoing research in improving patient outcomes.
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insights INSIGHT
The spectrum of PE risk
Risk stratification in PE is a spectrum, not a simple categorization.
Consider a holistic approach, combining biomarkers, imaging, and clinical assessment.
volunteer_activism ADVICE
Frontline PE Assessment
For frontline clinicians, prioritize not missing a PE diagnosis.
Use available tools like CT, biomarkers, vital signs, and clinical judgment for initial risk stratification.
question_answer ANECDOTE
High-Intermediate Risk PE Case
A 38-year-old man post-long flight presents with a PE, tachycardia, normal blood pressure, and elevated biomarkers.
Despite appearing comfortable, he's categorized as high-intermediate risk, requiring close monitoring and potential catheter-directed therapy if his condition worsens.
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On this week's release, Cyrus and Nick revisit one of their favorite topics: Pulmonary Embolism! In this episode - a follow up to our two-parter from season 1 - we sit down with Dr. Rick Channick of UCLA to talk about his approach to PE management with a focus on catheter directed therapies & PE response teams. This episode is packed full of expert insights and practical clinical pearls. Give it a listen and let us know what you think!
Risk Stratification Methodologies
What is the landscape of risk stratification in Pulmonary Embolism (PE)?
Broadly, what interventions does each risk category group warrant?
Rule of Thumb: The greater the risk to the patient, the more likely aggressive interventions will be considered.
Most patients with PE are low risk:
Typically treated with systemic anticoagulation
Excellent prognosis
High risk PE patients typically have hemodynamic involvement and can present in shock requiring emergent management :
No contraindications + shock due to PE systemic thrombolysis
Absolute contraindications:
Prior history of ICH
Known cerebrovascular lesion
Known malignant intracranial neoplasm
Non-acute ischemic stroke, within the last 3 months
Suspect aortic dissection
Intermediate risk patients:
Management options exist and are tailored to each specific patient.
Most, but not all, patients with PE deemed to be at intermediate risk will do well with systemic anticoagulation.
Some patients are good candidates for catheter directed therapies such as thrombectomy or thrombolysis.
Who? We don’t really know with a high degree of certainty. Considerations should be made for those with numerous risk factors for poor PE-related outcomes OR those with significant cardiopulmonary reserve / excellent functional status who theoretically could benefit from more brisk reversal of their acute pulmonary hypertension.
Critical Care Time