#Epi 36 - ICU Fellowship Snippet - Pulmonary Embolism: Risk Stratification & the New AHA/ACC Guidelines
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#Epi 36 - ICU Fellowship Snippet - Pulmonary Embolism: Risk Stratification & the New AHA/ACC Guidelines
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In this episode, Dr Swapnil Pawar and Dr Madhuri Anupindi work through a case-based viva on acute pulmonary embolism: a 40-year-old with a CTPA-proven saddle PE after a long-haul flight.
We cover:
– Risk stratification using the 2019 ESC guidelines: sPESI, haemodynamic criteria, and the imaging and biomarker evidence of RV strain
– The brand-new 2026 AHA/ACC guidelines and their A–E classification, including respiratory modifiers and SCAI shock stages
– Advantages and disadvantages of the new AHA/ACC framework versus the ESC approach — a likely compare-and-contrast question for the upcoming Fellowship exam
– Management of intermediate–high risk PE: anticoagulation (and why LMWH beats a heparin infusion), full-dose vs reduced-dose systemic thrombolysis (PEITHO, MOPETT), catheter-directed thrombolysis (HI-PEITHO), suction and surgical embolectomy, RV support strategies, and the role of the PERT team
Detailed tables comparing the ESC and AHA/ACC classifications, plus the sPESI criteria, are in the show notes at critcareedu.com.au.
Want to go deeper on the new guidelines? We break them down in full on the latest episode of the eCritCare Podcast.