PE Response at UNC

• Joint effort with VIR, Cardiology, MICU, CT Surgery, Cardiac anesthesia, Hematology, ED

• Pager is 123-7378 (123-PERT)

  • Group pager with VIR consult pager, CICU fellow (in-house 24/7), MICU fellow (in-house 24/7), MICU attending (in-house 24/7), CT Surgery fellow

  • Usually, pages will be initiated by ED but occasionally inpatient teams, OR, etc.

  • The idea is for all parties to converge on the patient and decide on treatment modality quickly according to the algorithm.

  • CICU fellow will perform bedside echo

• Together with the Cardiology division, VIR rotates weekly calls for catheter-directed therapies on patients with submassive PE

• Note that we still get the PERT page on the weeks we aren’t covering PE thrombolysis.

Landing Zone for Acute PE

• CICU is the current landing zone for ER or OSH presentations when systemic thrombolysis or catheter-directed therapies are being considered.

• CICU or TICU for patients with PE in transit when surgical or mechanical embolectomy is likely a treatment option.

• SICU for non-cardiac, post-operative patients, or patients with intra-OP acute PE.

• MICU is no longer the landing zone for acute PE patients due to COVID-19. This is likely to change in the near future given the scarcity of ICU beds and because most patients don’t need ICU level of care. Step-down is acceptable for thrombolytic patients. This is an RN issue currently under review.

VIR Fellow Role

• If the PERT pager is activated, see the patient if you are in-house.

• If not in the hospital, contact other team members (CICU fellow is probably best) to discuss treatment.

• If catheter-directed therapy is decided (thrombolytics or thrombectomy), VIR fellow should see the patient and staff consult with on-call VIR attending.

• The plan will be for the first case/early morning case.

• If the patient looks like impending CV collapse and may require ECMO, cardiology will perform the case.

Contraindications to Thrombolytics

• Stroke/TIA, head trauma, intracranial/intraspinal disease: < 1 year

• Bleeding from major organ: < 1 month

• Major surgery: < 7 days

• INR > 3 or aPTT > 50 (prior to heparin)

• History of HIT

• PLT < 100 or Hct < 30

• Clinician deems high risk for bleeding