Int J Angiol 2022; 31(03): 194-197
DOI: 10.1055/s-0042-1756176
Invited Article

Management of Massive Pulmonary Embolism

1   Department of Cardiology, Second Medical School, Charles University, Motol University Hospital, Prague, Czech Republic
,
Josef Veselka
1   Department of Cardiology, Second Medical School, Charles University, Motol University Hospital, Prague, Czech Republic
› Author Affiliations

Abstract

Pulmonary embolism is a potentially lethal manifestation of venous thromboembolic disease. It is one of the three main causes of cardiovascular morbidity and mortality in developed countries. Over the years, better diagnostic and risk stratification measures were implemented. A generous range of new treatment options is becoming available, particularly for management of massive pulmonary embolism. Nonetheless, clinicians often face uncertainty in clinical practice due to lack of scientific support for available treatment options. The aim of this article is to review management of massive pulmonary embolism.



Publication History

Article published online:
23 September 2022

© 2022. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Smith SB, Geske JB, Kathuria P. et al. Analysis of national trends in admissions for pulmonary embolism. Chest 2016; 150 (01) 35-45
  • 2 Raskob GE, Angchaisuksiri P, Blanco AN. et al. Thrombosis: a major contributor to global disease burden. J Thromb Haemost 2014; 12 (10) 1580-1590
  • 3 Konstantinides SV, Meyer G, Becattini C. et al; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J 2020; 41 (Suppl. 04) 543-603
  • 4 Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002; 121 (3, suppl): 877-905
  • 5 Rivera-Lebron B, McDaniel M, Ahrar K. et al; PERT Consortium. Diagnosis, treatment and follow up of acute pulmonary embolism: consensus practice from the PERT Consortium. Clin Appl Thromb Hemost 2019; 25: 1076029619853037
  • 6 Jaff MR, McMurtry MS, Archer SL. et al; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, American Heart Association Council on Peripheral Vascular Disease, American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123 (16) 1788-1830
  • 7 Smith SB, Geske JB, Maguire JM, Zane NA, Carter RE, Morgenthaler TI. Early anticoagulation is associated with reduced mortality for acute pulmonary embolism. Chest 2010; 137 (06) 1382-1390
  • 8 Bhat T, Neuman A, Tantary M. et al. Inhaled nitric oxide in acute pulmonary embolism: a systematic review. Rev Cardiovasc Med 2015; 16 (01) 1-8
  • 9 Ventetuolo CE, Klinger JR. Management of acute right ventricular failure in the intensive care unit. Ann Am Thorac Soc 2014; 11 (05) 811-822
  • 10 Lyhne MD, Dragsbaek SJ, Hansen JV, Schultz JG, Andersen A, Nielsen-Kudsk JE. Levosimendan, milrinone, and dobutamine in experimental acute pulmonary embolism. Pulm Circ 2021;11(03):20458940211022977
  • 11 Stevens SM, Woller SC, Kreuziger LB. et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest 2021; 160 (06) e545-e608
  • 12 Goldhaber SZ, Haire WD, Feldstein ML. et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993; 341 (8844): 507-511
  • 13 Konstantinides S, Tiede N, Geibel A, Olschewski M, Just H, Kasper W. Comparison of alteplase versus heparin for resolution of major pulmonary embolism. Am J Cardiol 1998; 82 (08) 966-970
  • 14 Daniels LB, Parker JA, Patel SR, Grodstein F, Goldhaber SZ. Relation of duration of symptoms with response to thrombolytic therapy in pulmonary embolism. Am J Cardiol 1997; 80 (02) 184-188
  • 15 Tapson VF. Acute pulmonary embolism. N Engl J Med 2008; 358 (10) 1037-1052
  • 16 McFadden PM, Ochsner JL. Aggressive approach to pulmonary embolectomy for massive acute pulmonary embolism: a historical and contemporary perspective. Mayo Clin Proc 2010; 85 (09) 782-784
  • 17 Goldberg JB, Spevack DM, Ahsan S. et al. Survival and right ventricular function after surgical management of acute pulmonary embolism. J Am Coll Cardiol 2020; 76 (08) 903-911
  • 18 Pasrija C, Kronfli A, Rouse M. et al. Outcomes after surgical pulmonary embolectomy for acute submassive and massive pulmonary embolism: A single-center experience. J Thorac Cardiovasc Surg 2018; 155 (03) 1095-1106.e2
  • 19 Neely RC, Byrne JG, Gosev I. et al. Surgical embolectomy for acute massive and submassive pulmonary embolism in a series of 115 patients. Ann Thorac Surg 2015; 100 (04) 1245-1252
  • 20 Giri J, Sista AK, Weinberg I. et al. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the american heart association. Circulation 2019; 140 (20) e774-e801
  • 21 Teleb M, Porres-Aguilar M, Rivera-Lebron B. et al. Ultrasound-assisted catheter-directed thrombolysis: a novel and promising endovascular therapeutic modality for intermediate-risk pulmonary embolism. Angiology 2017; 68 (06) 494-501
  • 22 Avgerinos ED, Jaber W, Lacomis J. et al; SUNSET sPE Collaborators. Randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism: the SUNSET sPE Trial. JACC Cardiovasc Interv 2021; 14 (12) 1364-1373
  • 23 Sista AK. Is it time to sunset ultrasound-assisted catheter-directed thrombolysis for submassive PE?. JACC Cardiovasc Interv 2021; 14 (12) 1374-1375
  • 24 Aso S, Matsui H, Fushimi K, Yasunaga H. In-hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5,263 patients using a national inpatient database in Japan. Crit Care 2016; 20 (01) 80
  • 25 Yusuff HO, Zochios V, Vuylsteke A. Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a systematic review. Perfusion 2015; 30 (08) 611-616
  • 26 Meneveau N, Guillon B, Planquette B. et al. Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases. Eur Heart J 2018; 39 (47) 4196-4204
  • 27 George B, Parazino M, Omar HR. et al. A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support. Resuscitation 2018; 122: 1-5
  • 28 Ghoreishi M, DiChiacchio L, Pasrija C. et al. Predictors of recovery in patients supported with venoarterial extracorporeal membrane oxygenation for acute massive pulmonary embolism. Ann Thorac Surg 2020; 110 (01) 70-75
  • 29 Kapur NK, Esposito ML, Bader Y. et al. Mechanical circulatory support devices for acute right ventricular failure. Circulation 2017; 136 (03) 314-326
  • 30 Porres-Aguilar M, Anaya-Ayala JE, Jiménez D, Mukherjee D. Pulmonary embolism response teams: pursuing excellence in the care for venous thromboembolism. Arch Med Res 2019; 50 (05) 257-258