Contemporary Management of Acute Pulmonary Embolism

Semin Thorac Cardiovasc Surg. 2020;32(3):396-403. doi: 10.1053/j.semtcvs.2020.04.002. Epub 2020 Apr 28.

Abstract

Multiple treatment options beyond anticoagulation exist for massive and submassive pulmonary embolism to reduce mortality. For some patients, systemic thrombolytics and catheter-directed thrombolysis are appropriate interventions. For others, surgical pulmonary embolectomy can be life-saving. Extracorporeal life support and right ventricular assist devices can provide hemodynamic support in challenging cases. We propose a management algorithm for the treatment of massive and submassive pulmonary embolism, in conjunction with a multidisciplinary pulmonary embolism response team, to guide clinicians in individualizing treatment for patients in a timely manner.

Keywords: Extracorporeal membrane oxygenation; Pulmonary embolism; Surgical embolectomy; Thrombolysis.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Algorithms
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use*
  • Clinical Decision-Making
  • Decision Support Techniques
  • Embolectomy* / adverse effects
  • Embolectomy* / mortality
  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Extracorporeal Membrane Oxygenation* / mortality
  • Heart-Assist Devices
  • Hemodynamics
  • Humans
  • Patient Selection
  • Prosthesis Design
  • Prosthesis Implantation* / adverse effects
  • Prosthesis Implantation* / instrumentation
  • Prosthesis Implantation* / mortality
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / mortality
  • Pulmonary Embolism / physiopathology
  • Pulmonary Embolism / therapy*
  • Recovery of Function
  • Risk Factors
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / mortality
  • Treatment Outcome
  • Ventricular Function, Right

Substances

  • Anticoagulants