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​NUHCS Services At Ng Teng Fong General Hospital: A Novel Approach To A Common Deadly Problem

NTFGH introduces new response team to treat life-threatening blood clots

PULSE Issue 39 | June 2022

National University Heart Centre, Singapore (NUHCS) @ Ng Teng Fong General Hospital (NTFGH) has established a multi-disciplinary team of cardiologists to form the new Pulmonary Embolism Response Team (PERT), which introduced a new approach to treat Pulmonary Embolism (PE), a critical condition whereby blood clots are lodged in one of the arteries in the lungs and block blood flow to the lungs, resulting in an increased survival rate of patients with high-risk PE to more than 98%. 

PE is the third leading cause of cardiovascular death in the world, after heart attack and stroke. The seriousness of the condition varies with the size of the blood clots, and their effect on obstructing blood circulation. Patients who also experience a sudden drop in blood pressure can be categorised as high-risk PE, a diagnosis which is life-threatening and requires immediate medical intervention. Patients who have PE may die within the first few hours, particularly for those with the more severe forms. If left untreated, two out of three patients with severe PE die within two hours after presentation, hence diagnosis and treatment should be rendered promptly. Conventional treatments of PE include blood thinning or clot-buster medications injected directly into the bloodstream to break down the clots. While waiting for the clots to dissolve, patients would have to be observed in the hospital’s Intensive Care Unit (ICU) for seven days or more. 

During this period, one in eight patients would have developed further complications such as excessive bleeding in the brain or digestive system. This makes the old method of treating PE risky and resource-intensive. In addressing the above, PERT has introduced two new minimally invasive techniques to remove the blood clots in patients with high-risk, life-threatening cases of PE. 

1. Ultrasound-Assisted Catheter-Directed Thrombolysis

This is a relatively novel therapy where the clots are broken up by clot-buster medications, together with high-intensity ultrasound emitted from the catheters delivered through a vein in the leg to the site of the clots. As a result, a much-reduced dosage of the clot-buster medication is required, greatly reducing the risk of bleeding complications.

2. Suction Thrombectomy 

This technique similarly uses a catheter, but engaged with a vacuum functionality instead to pull the clots out of the body. This technique is used when patients fail to respond to blood thinners or clot-busting medications. The PERT team is the first in Asia to use suction tools and the first in Southeast Asia to use ultrasound to treat PE. Since Apr 2021, 14 patients have been treated using one of the above two methods and have since fully recovered with no side effects.