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Patient Stories

Patient Benefits From Specialized Care For Pulmonary Embolism

Patient Benefits From Specialized Care For Pulmonary Embolism

Kathy clearly remembers the day she couldn’t climb the stairs in her home. She thought it was an asthma attack.

It was Sunday, Dec. 13, 2020, and she was outside for about an hour talking to a friend “and I came inside and couldn’t make it up the stairs,” said Kathy, then 63.

With symptoms like her prior asthma flare-ups, Kathy used her inhaler, which helped some. The next day she called Yale New Haven Hospital (YNHH) Winchester Center for Lung Disease where she is a patient of pulmonologist Jennifer Possick, MD. Kathy was prescribed prednisone and an antibiotic and over the next few days felt a bit better. On Wednesday she spoke with Shelley Harrigan, RN, of the center, who suggested Kathy buy a pulse oximeter to closely monitor her oxygen saturation at home and told her to call 911 if her oxygen levels dropped markedly. She had a COVID test and chest X-ray to check for pneumonia; both were negative.

Kathy was feeling OK Friday morning during a telehealth visit with Dr. Possick and her team but later that afternoon “I crashed. I got to the point where I couldn’t walk, I couldn’t breathe,” Kathy recalled. Her oxygen saturation dropped sharply into a dangerous range, prompting a 911 call. Kathy was rushed by ambulance to YNHH Emergency Department (ED). She was sweating profusely. “I was really, really bad,” she said, recalling the ED team quickly sprang into action. She was found to have low blood pressure and evidence of circulatory shock requiring special medication to support her blood pressure.

A CT pulmonary angiogram scan revealed a type of blood clot known as a pulmonary embolism (PE), which in Kathy’s case was extensive and causing her shock. Scan findings prompted an alert to the hospital’s Pulmonary Embolism Response Team (PERT) for care and treatment. In 2020, YNHH became the first healthcare institution in the world to use Aidoc artificial intelligence (AI) technology for PE detection that immediately notifies the PERT of a positive CT scan. The YNHH PERT includes pulmonologists, intensivists, interventional radiologists, cardiologists and sonographers, surgeons, hematologists and emergency medicine physicians, nurses and pharmacists.

A PE, which affects about one in 1,000 people, can block blood flow to the lungs and strain the heart. Symptoms include chest pain, difficulty breathing, lightheadedness or fainting, cough, palpitations, and low blood pressure. A massive or untreated PE may be associated with death.

That night, members of the PERT performed an emergency minimally invasive embolectomy to rapidly remove the pulmonary emboli in the lungs and reduce strain on her heart.

“We saw a significant improvement in her vital signs as clot was being removed and she was able to be weaned off oxygen and blood pressure medications quickly,” said Akhil Khosla, MD, director, Pulmonary Embolism Response Team, Yale New Haven Health, and assistant professor of Medicine, Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine.

Kathy said she felt “totally normal” when she arrived to the ICU early the next morning.

“The quick diagnosis and treatment by the ED team, coupled with our AI program allowed for rapid deployment of our PERT,” said Dr. Khosla. YNHH averages more than 250 PERT activations per year.

But Kathy soon received news of two other health findings. Her CT scan also showed a small lung nodule, found to be early-stage lung cancer. In April, surgery by thoracic surgeon Justin Blasberg, MD, at YNHH removed part of her lung’s left upper lobe. Since she had not smoked in many years, Kathy did not meet criteria for lung cancer screening. Also, with follow-up from the PERT outpatient staff, a blood test revealed an autoimmune disorder, antiphospholipid syndrome, which can trigger blood clots and is associated with pulmonary embolism.

“If it wasn’t for the pulmonary embolism, I would be living with lung cancer and not knowing it, and the blood disorder,” said Kathy, adding the embolism “saved my life in the long run.” She continues with checkups.

In a letter praising the care team, Kathy said, “They were AMAZING – kept me calm as they could and made all the right calls which saved my life! … They all worked as a well-oiled machine doing their very best in a stressful situation to get me the best care possible and save my life.” Kathy added she is also grateful for her ongoing care coordination from Dr. Possick and her team.

Today, Kathy walks for exercise. She is also an avid quilter, knitter and sewist. During the COVID-19 pandemic, she and friends have made more than 500 masks, including for patients of YNHH and Smilow Cancer Hospital. “The good that we did came back twofold,” said Kathy. “I’m thankful for everything I can do.”