Partners

Founded by brigham and women's hospital and massachusetts general hospital

Office of Continuing Professional Development

Pulmonary Embolism: What is Known and What We Need to Know... A State of the Art and Scientific Update

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Tuesday, June 28 - Wednesday, June 29, 2016

The Royal Sonesta Boston
40 Edwin H. Land Blvd
Cambridge, MA 02142

Description

Pulmonary embolism (PE) is a life-threatening condition that affects people of all ages and health status, from the most fit athletes to the most infirm patients. Detection of PE, "the great masquerader", can be challenging because the signs and symptoms are often subtle and mimic those of other disease states. Once PE is diagnosed, clinicians have little guidance in choosing from the wide array of therapies available because:

- No accepted and standardized algorithm to guide decision-making exists
- Outcomes data and evaluation for available therapies are lacking
- Care rendered to PE patients is fragmented among different clinical services
- Assessment of bleeding and other risks remains daunting
- Long-term effects of PE are poorly understood, though they can be severely debilitating

In the face of these challenges, multidisciplinary rapid-response programs promoting coordination among specialists for care of PE patients, such as the Pulmonary Embolism Response Team (PERT) initiative at Massachusetts General Hospital, have begun to gain traction. These initiatives hold the promise of:

- Improving interdisciplinary communication and collaboration
- Facilitating timely decision-making to enhance care
- Enabling systematic collection and evaluation of data related to PE treatment and outcomes

The purposes of this symposium are to improve detection, care coordination, and decision-making in managing patients with PE while expanding our knowledge of the underlying mechanisms, optimal initial treatment, and long-term follow-up strategies for PE.

Learning Objectives

Upon completion of this activity, participants will be able to:

1) Identify low, moderate and high risk PE
2) Develop a diagnostic and treatment algorithm for PE that incorporates risk stratification and meets the specific needs of patients presenting with symptoms/signs suggestive of PE
3) Select between various treatment options for moderate and high-risk PE patients including anticoagulation (type of agent and delivery mode), IVC filter implementation, thrombolysis (intravenous and catheter-directed), extra-corporeal membrane oxygenation (ECMO), suction thrombectomy and open surgical thrombectomy
4) Recognize the potential complications of PE and how to prevent and treat them
5) Describe the unique patient populations with PE and their specific treatment challenges
6) Apply standards of care for post-PE long-term management and surveillance

Target Audience

This activity is intended for clinicians who diagnose and/or treat patients with pulmonary embolism (PE); academics and scientists who study pulmonary embolism.

Agenda

DAY 1 - TUESDAY, JUNE 28, 2016:

7:00 am

Breakfast and Registration

8:00

Welcome and Opening Remarks
Kenneth Rosenfield & Rachel Rosovsky

Pulmonary Embolism: The Global Crisis
Moderators: Kenneth Rosenfield & Harold Palevsky

8:10

Epidemiology of PE: Global and Local
Samuel Goldhaber

8:25

Back of the Napkin Calculations... The Global Cost of PE: Implications for Patients, Families, Health Care Delivery Systems, and Society
Harold Palevsky

Predisposing Factors and Diagnostic Challenges of PE
Moderators: Christopher Kabrhel & Victor Tapson

8:40

Risk Factors Predisposing to PE: Comprehensive Review
Gregory Piazza

8:55

When to look For PE and in which patients? (What are the signs, symptoms, background factors that alert one to look for PE?)
Christopher Kabrhel

9:10

How to look for PE: Personalizing the work up for PE
Jeffrey Kline

9:25

PE... The Great Masquerader... A disease of many faces: Cases where I was fooled!
Victor Tapson

Imaging in PE - Key to Diagnosis and Risk Stratification
Moderators: Brian Ghoshhajra & Jeffrey Olin

9:35

CT Imaging PE: Is this the go-to test for urgent diagnosis and risk-stratification? Should every CT PE study include imaging of IVC and pelvic veins?
Brian Ghoshhajra

9:50

Echocardiography in PE: Patient Selection and Timing... Impact On Treatment Decisions
David Dudzinski

10:00

Break

10:25

Case Challenges (Cases of Echos, CTA's, with Unusual/Interesting/ Unexpected Findings) - audience polling
Josanna Rodriguez-Lopez, Seth Sokol, & Matthew Langston

Special Session: Assessing Algorithms and Guidelines for Management of PE
Moderators: Michael Jaff & Philip Wells

10:40

What do the latest guidelines tell us about classification and risk stratification... comparing and contrasting US & European guidelines?
Nils Kucher

10:55

Troponin, BNP, D-dimer, lactate, PESI, Geneva: Are biomarkers and clinical risk scores useful for risk stratification or not?
Philip Wells

11:10

Current guidelines, classification schema, and risk stratification algorithms: Do we have them right? What is needed to make them better?
Clive Kearon

11:25

Panel Discussion
Panelists: Nils Kucher, Philip Wells, Clive Kearon, Richard Channick, Victor Tapson, Samuel Goldhaber, Jeffrey Olin

Defining PE Severity During Initial Triage - The Bipolar Spectrum of PE
Moderators: Ido Weinberg & Jana Montgomery

11:40

Which truly low risk PE patient can I discharge home and what must be in place to manage as an outpatient?
Geno Merli

11:50

What is a PERT and how can it work to help triage the PE patient? Demonstration case and description...
Kenneth Rosenfield

12:00 p.m.

Panel Discussion: Team-based approach to PE... Does it aid decision-making and enhance outcomes, or just increase complexity, waste resources, and delay therapy?
Panelists: Ido Weinberg, Geno Merli, Jana Montgomery, Kenneth Rosenfield, Gregory Piazza

12:15

National PERT Consortium - What is it about and how do I join and participate? ... Q&A *
Jana Montgomery

12:20

Lunch

Anticoagulation Therapy: The Backbone of Treatment
Moderators: Richard Channick & Geoffrey Barnes

1:35

When is anticoagulation a primary therapy for PE? How does one initiate and transition, and what are the options?
Craig Kessler

1:50

Novel Anticoagulants (NOACs): The data in standard and high-risk patients... which ones when? Are these now first-line therapy?
Rachel Rosovsky

2:05

Prime time for reversal agents: Latest data, how and when to use them... and will they tilt the balance in favor of NOACs over traditional agents?
George Davis

Overview of Advanced Therapy in the Current Era: What's Out There and When to Use It
Moderators: Robert Lookstein & Thoralf Sundt

2:20

Intravenous Thrombolytic Therapy for PE: When (if ever) is it clearly indicated in the current era? Do novel interventions make this treatment passe? Which patients truly cannot receive lytic therapy for PE?
Jeffrey Olin

2:35

Catheter-directed thrombolysis (CDT) and Pharmacomechanical lysis (PMT): What do recent studies show about early and intermediate-term outcomes? Who should be considered for this approach? Who has absolute contraindication?
Richard Channick

2:50

Thrombo-aspiration - Latest options, case selection, outcomes?
Robert Lookstein

3:05

Surgical Thromboembolectomy For Massive and Submassive PE: When, How, and Why (with historial perspective)
Thoralf Sundt

3:20

Break

Where Did This Thrombus Come From... And How Does It Influence Therapy?
Moderators: Christopher Kabrhel & Roy Smith

3:40

Cherchez le clot... How important is it to do an exhaustive search for the "smoking gun"? And what is reasonable to do to find it? Does thrombus location ands size affect selection of therapy?
Ido Weinberg

3:50

That IVC filter - do we really need it and when? And for how long?
Michael Jaff

Unique Patient Substrates - Special Considerations?
Moderators: Rachel Rosovsky & Jerry Bartholomew

4:00

Thrombocytopenic Patients and Coagulopathic Patients
TBD

4:10

Clot-in-transit? How to assess, manage, and prevent the Sword of Damocles from dropping
John Moriarty

4:15

Patients at risk for intracranial (or other) bleeding
Robert Schainfeld

4:20

The trauma patient and the post-surgical patient
George Velmahos

4:25

The pregnant patient
Jerry Bartholomew

4:30

Terminal Cancer: Consideration of prognosis and ethical issues in decision-making
TBD

4:45

BREAKOUT SESSIONS - SELECT ONE:

Breakout Session I - Inpatient PE Management
Session Leaders: Richard Channick, Ido Weinberg, & Alison Witkin
Evaluation for hypercoagulable state: should it be done and, if so, what to measure and when? How does it alter management?
--Roy Smith
Inpatient management of PE: Can PE patients be managed on a monitored floor? Special management considerations for the intensivist caring for patients with acute PE
--Daniel Schimmel
Appropriate selection and dosing of meds and management of ventilators and support devices
--Richard Channick
Supporting the Rt heart - Role of pharmacologic agents, NO, RV mechanical support (e.g. Impella/RVAD), ECMO
--Seth Sokol

Breakout Session II - After The PE: The Outpatient Experience
Session Leaders: Rachel Rosovsky, Josanna Rodriguez-Lopez, & Samuel Goldhaber
Optimal follow-up regimen and testing (imaging, hematologic, genetic)
--Samuel Goldhaber
Post-PE anticoagulation - important considerations that influence selection of agents
--Geoffrey Barnes
Setting up and conducting a multidisciplinary PE follow-up clinic
--Rachel Rosovsky
How and when to search for CTEPH in survivors of serious PE
--Josanna Rodriguez-Lopez
Caring for the patient after PE - PTSD and the importance of support networks
--Kelly Sawyer

Breakout Session III - Creating a PERT... What You Need to Know
Session Leaders: Kenneth Rosenfield, Christopher Kabrhel, & Belinda Rivera
Nuts and bolts of how to set up a PERT - bringing together sub-specialists, creating virtual meetings, developing protocols, collecting data
--Kenneth Rosenfield, MD
PERT challenges and conundrums - case after case
--Belinda Rivera and faculty

5:30 p.m.

Adjourn Day 1

3:00-5:00 p.m.

Poster Session I - posters displayed from 3:00 - 5:00 PM *

DAY 2 - WEDNESDAY, JUNE 29, 2016:

7:00 am

Breakfast

8:00

Welcome and opening remarks: a case challenge from a PERT consortium member
Kenneth Rosenfield & Rachel Rosovsky

Evolving Algorithms for Management of Massive and Submassive PE
Moderators: Michael Jaff & Richard Channick

8:15

Presentation of algorithms from representatives from PERT sites
Gustavo A. Heresi (Rochester); David Slosky (Vanderbilt); Sanjay Misra (Mayo Clinic)

8:45

Case-based discussion: My most challenging case and "PERT" decision in the past year
Jerry Bartholomew, James Benenati, Jana Montgomery, & Daniel Schimmel

PE: The Research Mandate
Moderators: Christopher Kabrhel & Samuel Goldhaber

9:15

What we still need to learn about PE... What are the major gaps in our knowledge base? Non-invasive perspective
Philip Wells

9:25

What we still need to learn about PE... What are the major gaps in our knowledge base? Invasive perspective
Jay Giri

9:35

Filling the knowledge gap: Can the PERT Consortium be the vehicle for definitive multi-center trials for PE therapy? How to participate, and snapshot of what the data has shown us so far
Akhilesh Sista

Poster Presentations and Patient Perspectives

9:45

Scientific Presentations
Poster competition winners

10:00

Patient Perspectives: a) Living with PE; b) Living with CTEPH
Alison Witkin

10:20

Break

10:45

MORNING WORKSHOPS - SELECT ONE:

Workshop I - Nuts and Bolts of Interventional Therapies - Results; Technical Tips and Tricks; Hands-on Experience
Workshop Leaders: Douglas Drachman, John Moriarty, & James Benenati
CDT - Infusion catheters and ultrasound-enhanced infusion
--Joseph Garasic
Thromboaspiration - Devices and technique
--James Benenati
En Bloc Thromboaspiration with Veno-veno Bypass
--John Moriarty
Open pulmonary thrombectomy - technical considerations
--Mauricio Villavicencio
RV mechanical support devices - will they be effective and how to use them
--Douglas Drachman & Sunu Thomas
Large vein access and closure - how I do it
--Robert Maholic
Hands-on experience; Questions and Answers; Wrap-up
--All faculty

Workshop II - CTEPH Symposium
Workshop Leaders: Richard Channick, Victor Tapson, & Ehtisham Mahmud
Defining the incidence and impact of CTEPH: Can we predict which PE patients get it and which don't? How should we detect/screen for it and then monitor over time?
--Richard Channick
How do I follow these patients and what is my threshold for intervention?
--Josanna Rodriguez-Lopez
Open thromboendearterectomy... how it is done and what are the outcomes? MGH experience!
--Cameron Wright
Pulmonary artery balloon dilation... technique, patient selection, outcomes... is this the future?
--Ehtisham Mahmud
Discussion; Questions and Answers; Wrap-up
--All faculty

Workshop III - DVT Sympsosium
Workshop Leader: Rachel Rosovsky
Prevalence, causes, and prevention
--TBD
Triage in the office or ED... which cases should I worry about?
--Gregory Piazza
The spectrum of treatment modalities - what is available and when to apply
--TBD
Anticoagulation - selection of anticoagulant agents to fit the patient
--Rachel Rosovsky
Does aggressive treatment with clot lysis and rapid restoration of flow have any impact on subsequent events or quality of life?
--Sanjay Misra
Clot removal or lysis?
--TBD
Discussion; Questions and Answers; Wrap-up
--All faculty

12:15 p.m.

Lunch

12:30

AFTERNOON DIDACTIC/HANDS-ON WORKSHOPS - SELECT ONE:

Workshop IV - IVC Symposium
Workshop Leaders: Michael Jaff, Robert Lookstein, & Nils Kucher
Appropriate use of Vena Cava Filters in PE: in which patients and when
--Michael Jaff
Spectrum of available devices and how each work - what are the data?
--Thomas Todoran
Bedside IVC filter placement made easy - technical how-to
--Robert Lookstein
Tracking and removal of IVC filters - overstated importance or failed mandate? Ideal tracking models - show us how you do it
--Ido Weinberg
Removal of the "difficult" IVC filter: embedded, tilted, penetrating
--Gregory Walker
The occluded IVC: how common a problem is this? What are the causes and manifestations?
--John Kaufman
The occluded IVC: therapeutic options and outcomes
--Nils Kucher
Hands-on experience with IVC filters, snares, biopsy forceps, and other devices
--All faculty

Workshop V - Hemodynamic Support: ECMO, IMPELLA-RP, Other - How and When to Use, and Can They Change the Game?
Workshop Leaders: David D'Alessandro, Michael Fitzsimons, Sunu Thomas, Mauricio Villavicencio, Wissam Jaber, & Jay Giri
History of mechanical support: how-to-do, when-to-do, where-to-do, who-should-do?
How to set up a team and algorithms: who should do it and where; Impella versus V-A versus V-V
Complications and management of devices
Vascular access and closure issues
Use of other therapies in conjunction - lysis, thrombectomy, other
Ethical consideration regarding cessation of support
Hands-on experience with Impella, ECMO, Vortex devices
--All faculty

2:00 p.m.

Program Concludes

*Not part of the CME activity

Faculty

Course Directors:
Kenneth Rosenfield, MD, MHCDS
Section Head, Vascular Medicine and Intervention,Division of Cardiology,Massachusetts General Hospital

Rachel Rosovsky, MD, MPH
Hematologist and Medical Oncologist,Massachusetts General Hospital
Instructor in Medicine, Harvard Medical School

Course Co-Directors:
Richard N. Channick, MD
Director, Pulmonary Hypertension and Thromboendarterectomy Program,Massachusetts General Hospital
Associate Professor of Medicine, Harvard Medical School

Samuel Goldhaber, MD
Section Head, Vascular Medicine; Director, Thrombosis Research Group,Cardiovascular Division,Brigham and Women's Hospital
Professor of Medicine, Harvard Medical School

Michael R. Jaff, DO
Medical Director, Fireman Vascular Center; Medical Director, Center for Specialized Services; Founder and Medical Director, Vascular Ultrasound Core Laboratory, Massachusetts General Hospital

Christopher Kabrhel, MD, MPH
Director, Center for Vascular Emergencies, Department of Emergency Medicine,Massachusetts General Hospital
Associate Professor of Surgery, Harvard Medical School

Massachusetts General Hospital Faculty:
David D'Alessandro, MD
Douglas Drachman, MD
David Dudzinski, MD
Michael Fitzsimons, MD
Joseph Garasic, MD
Brian Ghoshhajra, MD
Thomas Lynch, MD
Josanna Rodriguez-Lopez, MD
Robert Schainfeld, DO
Thoralf Sundt, MD
Sunu Thomas, MD
George Velmahos, MD, PhD
Mauricio Villavicencio, MD, MBA
Gregory Walker, MD
Ido Weinberg, MD
Alison Witkin, MD
Cameron Wright, MD

Invited Faculty:
Geoffrey Barnes, MD
University of Michigan Health System, Ann Arbor, MI

John (Jerry) Bartholomew, MD
Cleveland Clinic, Cleveland, OH

James Benenati, MD
Miami Baptist Hospital, Miami, FL

George Davis, PharmD
University of Kentucky Medical Center, Lexington, KY

Jay Giri, MD, MPH
Hospital of the University of Pennsylvania, Philadelphia, PA

Gustavo Heresi, MD
Cleveland Clinic, Cleveland, OH

Wissam Jaber, MD
Emory University Hospital, Atlanta, GA

John Kaufman, MD
Oregon Health Science University Hospital, Portland, OR

Clive Kearon, MB, MRCPI, FRCPC, PhD
McMaster University, Hamilton, Ontario

Craig Kessler, MD
Georgetown University Medical Center, Washington, DC

Jeffrey Kline, MD
Indiana University Medical Center, Indianapolis, IN

Nils Kucher, MD
Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland

Matthew Langston, MD
Jacobi Medical Center, New York, NY

Robert Lookstein, MD
Mount Sinai Medical Center, New Orleans, LA

Ehtisham Mahmud, MD
University of California San Diego, San Diego, CA

Robert Maholic, DO
University of Pittsburgh Medical Center, Pittsburgh, PA

Geno Merli, MD
Jefferson University Hospitals/Sidney Kimmel Medical College, Philadephia, PA

Sanjay Misra, MD
Mayo Clinic Hospitals, Rochester, MN

Jana Montgomery, MD
Lahey Hospital & Medical Center, Burlington, MA

John Moriarty, MD
University of California Los Angeles Medical Center, Los Angeles, CA

Jeffrey Olin, DO
Mount Sinai Medical Center, New York, NY

Harold Palevsky, MD
Hospital of the University of Pennsylvania, Philadelphia, PA

Gregory Piazza, MD
Brigham and Women's Hospital, Boston, MA

Belinda Rivera, MD
University of Pittsburg Medical Center, Pittsburgh, PA

Kelly Sawyer, MD
William Beaumont Hospital, Royal Oak, MI

Daniel Schimmel, MD
Northwestern UniversityHospital, Chicago, IL

Akhilesh Sista, MD
New York-Presbyterian Hospital, New York, NY

Roy Smith, MD
University of Pittsburgh Medical Center, Pittsburgh, PA

Seth Sokol, MD
Montefiore Hospital, Albert Einstein College of Medicine, New York, NY

Victor Tapson, MD
Cedars-Sinai Medical Center, Los Angeles, CA

Thomas Todoran, MD, MSc
Medical University of South Carolina, Charleston, SC

Philip Wells, MD
The Ottawa Hospital, University of Ottawa, Ottawa, Ontario

Registration Fees

Physicians: $495
Other Healthcare Professionals: $195
Residents/Fellows: Free

Continental breakfast, lunch and coffee breaks provided.

Cancellation Policy:
Registrations cancelled on or before June 14, 2016 will be refunded, less a $40 administrative fee. Registrations cancelled after June 14th will not be refunded.

Contact partnerscpd@partners.org if you require assistance in cancelling your online registration.

Accommodations

A limited number of rooms have been made available for attendees at a special group rate at Royal Sonesta Boston, 40 Edwin Land Boulevard Cambridge, MA.

To reserve your room online, go to: http://bit.do/MGHPE2016

If you prefer, call 617.806.4200 and specify that you are enrolled in the MGH PE Meeting and use group code 0626MGHCAR to receive the reduced room rate.

Contact

For questions regarding the conference, contact Michelle Lanno at mlanno@partners.org.

For questions regarding registration, contact Partners Office of Continuing Professional Development at partnerscpd@partners.org or 617-535-6453.

Provided by:

Massachusetts General Hospital Fireman Vascular Center and Partners HealthCare System

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CME Information

Accreditation
Partners HealthCare System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Partners HealthCare System designates this live activity for a maximum of 12.5 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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