Guarnieri Gianluca, Constantin Filip David, Pedrazzini Giovanni, Ruffino Maria Antonella, Sürder Daniel, Petrino Roberta, Zucconi Enrico Carlo, Gabutti Luca, Ogna Adam, Balestra Brenno, Valgimigli Marco
Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
J Clin Med. 2024 Apr 23;13(9):2457. doi: 10.3390/jcm13092457.
The Swiss Ticino regional pulmonary embolism response team (PERT) features direct access to various pharmacomechanical PE management options within a hub/spoke system, by integrating evidence, guidelines' recommendations and personal experiences. This system involves a collaborative management of patients among the hospitals distributed throughout the region, which refer selected intermediate-high or high PE patients to a second-level hub center, located in Lugano at Cardiocentro Ticino, belonging to the Ente Ospedaliero Cantonale (EOC). The hub provides 24/7 catheterization laboratory activation for catheter-based intervention (CBI), surgical embolectomy and/or a mechanical support system such as extracorporeal membrane oxygenation (ECMO). The hub hosts PE patients after percutaneous or surgical intervention in two intensive care units, one specialized in cardiovascular anesthesiology, to be preferred for patients without relevant comorbidities or with hemodynamic instability and one specialized in post-surgical care, to be preferred for PE patients after trauma or surgery or with relevant comorbidities, such as cancer. From April 2022 to December 2023, a total of 65 patients were referred to the hub for CBI, including ultrasound-assisted catheter-directed thrombolysis (USAT) or large-bore aspiration intervention. No patient received ECMO or underwent surgical embolectomy.
瑞士提契诺州区域肺栓塞反应团队（PERT）通过整合证据、指南建议和个人经验，在枢纽/辐条系统中能够直接采用多种药物机械性肺栓塞管理方案。该系统涉及整个地区各医院之间对患者的协同管理，这些医院将选定的中高或高危肺栓塞患者转诊至位于卢加诺的提契诺心脏中心的二级枢纽中心，该中心隶属于提契诺州立医院管理局（EOC）。枢纽中心提供全天候导管实验室激活服务，用于基于导管的介入治疗（CBI）、外科血栓切除术和/或机械支持系统，如体外膜肺氧合（ECMO）。在经皮或手术干预后，枢纽中心将肺栓塞患者收治在两个重症监护病房，一个专门从事心血管麻醉，适合无相关合并症或血流动力学不稳定的患者；另一个专门从事术后护理，适合创伤或手术后的肺栓塞患者或有相关合并症（如癌症）的患者。从2022年4月到2023年12月，共有65例患者被转诊至枢纽中心接受CBI，包括超声辅助导管直接溶栓（USAT）或大口径抽吸介入治疗。没有患者接受ECMO或接受外科血栓切除术。
