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Pulmonary embolism response team improves diagnosis and care coordination

By Thomas Fahrbach, MD, interventional radiologist

fahrbach-thomas-BWP0009ZPulmonary embolism (PE) is a common, lethal problem that can strike the fittest athletes to the frailest patients. In fact, some call it a national crisis. PE has a high early mortality and is underdiagnosed and undertreated. There is no global understanding of the best therapy or treatment procedure. And an estimated 60,000 to 100,000 Americans die each year from PE/deep vein thrombosis1, making it the third most common type of cardiovascular disease after coronary artery disease and stroke.

Expert detection

PE occurs when a blood clot develops from a distal source, such as the deep veins of the legs, and travels to the lungs, where the clot blocks the pulmonary artery, stopping blood flow and causing sudden death. Clots can form wherever there is stagnant blood, injury to the vessels or hypercoagulation.

Diagnosis can be difficult for two reasons:

  • Accuracy. PE has been called the "great masquerader" because it can mimic other conditions and be difficult to detect. For example, patients suffering from submassive PE may come to your office complaining of shortness of breath or mild chest pains, which could be caused by any other number of conditions from anxiety to pneumonia, when the true cause is a small blood clot that reduces blood flow and damages lung tissue. Patients with massive PE present with severe, sudden symptoms that would suggest stroke or myocardial infarction.

  • Time. If misdiagnosed or if treatment is delayed, acute PE can be deadly. In fact, two out of every three patients die within two hours of presenting. 

Our PE team has the experience to quickly interpret initial clinical exams and diagnostic testing, including noninvasive studies, such as CT scans and ultrasound, to arrive at an accurate diagnosis and recommend the most effective treatment option.

Referral guidelines

We welcome referrals and offer these guidelines to physicians in their decisions to direct patients to our PE team:

  • If your patient exhibits severe chest pains or breathing problems
  • If your patient has been immobilized due to prolonged car rides, plane trips or postoperative recovery – particularly orthopedic surgery
  • If your patient is pregnant, takes oral contraceptives, smokes or has high blood pressure

Multispecialty, emergent care

The level of care provided to patients with life-threatening PE sets The University of Kansas Health System apart from community hospitals. We are the only health system in the area with a multispecialty team prepared to emergently treat PE patients 24/7.

Our pulmonary embolism response team is a group of specialists who provide coordinated, rapid-response care according to a standardized treatment procedure and through a heightened level of communication. It involves services spanning the emergency room and pulmonary/critical care to interventional radiology and cardiothoracic surgery.

We coordinate care from the time the patient enters the interventional radiology endovascular suite to the ICU management postprocedure. We actively and closely manage each patient's care with inpatient rounds and our outpatient clinic service.

Our approach fosters consistency across the care spectrum and speeds diagnostic and therapeutic decision-making in an environment in which delays can be deadly. This puts us in the best position to achieve optimal outcomes for your patients.

New, advanced treatment options

The University of Kansas Health System offers the most innovative PE procedures. Backed by an advanced care team and critical care support, we tailor the treatment to the individual, offering options including:

  • Removable IVC filters. These small, implanted devices capture loose blood clots traveling to the heart and lungs. These filters can be removed once the patient is no longer at risk.

  • Noninvasive catheter-directed therapy. This is a first line of therapy for patients who cannot receive standard IV medications or who wouldn't survive the time required for medical therapy. Catheter-directed therapy delivers smaller doses of the powerful clot-busting drug tPA. These smaller doses dramatically reduce the risk of bleeding. Further, catheter-directed thrombolysis is a nonsurgical procedure, performed without the need for anesthesia, incisions, scarring or recovery time.

  • Thrombectomy. This procedure is applied to break the clot into smaller pieces and literally suck them out of the blood vessel, immediately relieving strain on the heart and improving oxygenation.

These new procedures add to The University of Kansas Health System's already potent treatment arsenal for the most complex and advanced PE scenarios.

A new level of care

Hospitals experience significant challenges when assembling a multidisciplinary, rapid-response plan of care for emergent PE conditions. Our coordinated and accepted treatment plan makes diagnostic and therapeutic decision-making much easier and prevents fragmented care among different clinical services. Our goal is to break through to the next level of care by improving PE diagnosis and care coordination, using the most advanced technology available.

Dr. Thomas Fahrbach is an interventional radiologist at The University of Kansas Health System and serves as an assistant professor at the University of Kansas Medical Center. Dr. Fahrbach's specialties include radiology, diagnostic radiology, diagnostic roentgenology, emergency radiology and endovascular surgery. He is board-certified in diagnostic radiology.

1The Center for Disease Control and Prevention. https://www.cdc.gov/ncbddd/dvt/data.html. Retrieved June 2017.