To Lyse or not to Lyse?

Title: To Lyse or not to Lyse?
Author(s): R Deshpande A Murray C Donaghy A Livingstone E Hayes
Institution: Daisy Hill Hospital, Southern Trust
Poster: Click to view poster
Category: General Respiratory and Sleep
Abstract: Pulmonary embolism (PE) is a significant cause of death and morbidity, 5% of all hospital deaths are attributable to PE. Prompt recognition and treatment are essential for minimizing the mortality and morbidity associated with PE.
Lysis decisions remain challenging for physicians. In massive PE, with haemodynamic collapse, the robust evidence base for the administration of fibrinolysis is well defined. However, there has been considerable debate on the benefits of lysis in sub-massive PE as evidenced by the Peitho trial (1)
We are nearing completion of a comprehensive trust wide protocol to help guide these decisions whilst still allowing an individualized approach to patient care. This protocol involved evidenced based analysis and inter-departmental collaboration. An extensive teaching programme on the protocol has been implemented prior to its trust-wide roll out.
Our work on this project has highlighted the complexity surrounding decision making in critically ill patients who are being considered for lysis. Our protocol sets out comprehensive guidance which is evidence based to help standardize patient care.

(1) Fibrinolysis for patients with intermediate-risk Pulmonary embolism
Meyer G, et al. N Engl J Med. 2014 Apr 10;370 (15):1402-11