Puneet Gandotra, MD: Pulmonary Embolism Response Teams

Puneet Gandotra, MD, the director of the Cardiac Catheterization Lab at Southside Hospital spoke with MD Magazine about Northwell Health’s and Southside Hospital’s pulmonary embolism response teams. Each is a multidisciplinary team—made up of an interventional cardiologist, a cardiothoracic surgeon, a pulmonologist, a hematologist, and the critical care team—that works together to provide better and more aggressive treatment for patients.

Puneet Gandotra, MD, the director of the Cardiac Catheterization Lab at Southside Hospital:

One of the other trends that I would have never even thought of—and during my training never even imagined I would be part of—is something called the pulmonary embolism response team. PE, or pulmonary embolisms—no one really owned pulmonary embolisms [in terms of treatment], if you want to call it that. I mean it was the pulmonary physicians that always treated them just because patients showed up in their offices or in the hospital. They weren't the first ones to be called.

But our treatment for pulmonary embolism has been lacking. The people who show up—or patients who show up—with the massive or submassive pulmonary embolisms can be crippled for life because of things like pulmonary hypertension that can develop if those pulmonary embolisms are not treated appropriately. We've become a lot more aggressive and now the catheter-based mechanisms for treatment of pulmonary embolisms have evolved significantly.

What we know is that if we give clot-busting medication, or TPA, to these pulmonary emboli, they tend—patients tend—to do better. But we also know that TPA, or clot-busting medication, can cause significant bleeding including intracranial and abdominal bleeding. So what we've done is we've created pulmonary embolism response teams and we created one of those actually at Southside also.

As soon as a massive PE or a submassive PE patient presents themselves in the emergency room, the interventional cardiologist, cardiothoracic surgeon, pulmonary, hematology, and our critical care teams are involved right away. And we basically make the best decision as to how to treat these patients. Number one, is that patient going to surgery for an embolectomy? [We decide if] this patient going for full dose TPA or is this patient better off with a catheter-based technique, where we put up catheters inside the heart, go through the heart into the lungs, and essentially drip clot-busting medications for 12 to 24 hours and then reassess.

This has been a phenomenal program, and we've developed this and have brought in patients from out east from Peconic Medical Center, from Huntington, from other hospitals in the eastern region of Southside, to really grow this program and make it into a new entity. It's something that's very unique to Long Island and because I think, probably in another decade I think this will be a trend which everybody will be following, but I think [Southside and Northwell Health] are definitely at the forefront of this at this time.

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