Management of high-risk pulmonary embolism in the emergency department : A narrative review
Published by Elsevier Inc..
BACKGROUND: High-risk pulmonary embolism (PE) is a complex, life-threatening condition, and emergency clinicians must be ready to resuscitate and rapidly pursue primary reperfusion therapy. The first-line reperfusion therapy for patients with high-risk PE is systemic thrombolytics (ST). Despite consensus guidelines, only a fraction of eligible patients receive ST for high-risk PE.
OBJECTIVE: This review provides emergency clinicians with a comprehensive overview of the current evidence regarding the management of high-risk PE with an emphasis on ST and other reperfusion therapies to address the gap between practice and guideline recommendations.
DISCUSSION: High-risk PE is defined as PE that causes hemodynamic instability. The high mortality rate and dynamic pathophysiology of high-risk PE make it challenging to manage. Initial stabilization of the decompensating patient includes vasopressor administration and supplemental oxygen or high-flow nasal cannula. Primary reperfusion therapy should be pursued for those with high-risk PE, and consensus guidelines recommend the use of ST for high-risk PE based on studies demonstrating benefit. Other options for reperfusion include surgical embolectomy and catheter directed interventions.
CONCLUSIONS: Emergency clinicians must possess an understanding of high-risk PE including the clinical assessment, pathophysiology, management of hemodynamic instability and respiratory failure, and primary reperfusion therapies.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:79 |
|---|---|
| Enthalten in: |
The American journal of emergency medicine - 79(2024) vom: 06. Apr., Seite 1-11 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Rouleau, Samuel G [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Cardiac arrest |
|---|
| Anmerkungen: |
Date Completed 16.04.2024 Date Revised 27.04.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.ajem.2024.01.039 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM368203638 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM368203638 | ||
| 003 | DE-627 | ||
| 005 | 20240427232056.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240209s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.ajem.2024.01.039 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1390.xml |
| 035 | |a (DE-627)NLM368203638 | ||
| 035 | |a (NLM)38330877 | ||
| 035 | |a (PII)S0735-6757(24)00052-4 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Rouleau, Samuel G |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Management of high-risk pulmonary embolism in the emergency department |b A narrative review |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 16.04.2024 | ||
| 500 | |a Date Revised 27.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published by Elsevier Inc. | ||
| 520 | |a BACKGROUND: High-risk pulmonary embolism (PE) is a complex, life-threatening condition, and emergency clinicians must be ready to resuscitate and rapidly pursue primary reperfusion therapy. The first-line reperfusion therapy for patients with high-risk PE is systemic thrombolytics (ST). Despite consensus guidelines, only a fraction of eligible patients receive ST for high-risk PE | ||
| 520 | |a OBJECTIVE: This review provides emergency clinicians with a comprehensive overview of the current evidence regarding the management of high-risk PE with an emphasis on ST and other reperfusion therapies to address the gap between practice and guideline recommendations | ||
| 520 | |a DISCUSSION: High-risk PE is defined as PE that causes hemodynamic instability. The high mortality rate and dynamic pathophysiology of high-risk PE make it challenging to manage. Initial stabilization of the decompensating patient includes vasopressor administration and supplemental oxygen or high-flow nasal cannula. Primary reperfusion therapy should be pursued for those with high-risk PE, and consensus guidelines recommend the use of ST for high-risk PE based on studies demonstrating benefit. Other options for reperfusion include surgical embolectomy and catheter directed interventions | ||
| 520 | |a CONCLUSIONS: Emergency clinicians must possess an understanding of high-risk PE including the clinical assessment, pathophysiology, management of hemodynamic instability and respiratory failure, and primary reperfusion therapies | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Cardiac arrest | |
| 650 | 4 | |a High-risk pulmonary embolism | |
| 650 | 4 | |a Massive pulmonary embolism | |
| 650 | 4 | |a Pulmonary | |
| 650 | 4 | |a Pulmonary embolism | |
| 650 | 4 | |a Thrombolytics | |
| 650 | 4 | |a Vascular | |
| 650 | 4 | |a Venous thromboembolism | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 700 | 1 | |a Casey, Scott D |e verfasserin |4 aut | |
| 700 | 1 | |a Kabrhel, Christopher |e verfasserin |4 aut | |
| 700 | 1 | |a Vinson, David R |e verfasserin |4 aut | |
| 700 | 1 | |a Long, Brit |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The American journal of emergency medicine |d 1986 |g 79(2024) vom: 06. Apr., Seite 1-11 |w (DE-627)NLM01297868X |x 1532-8171 |7 nnns |
| 773 | 1 | 8 | |g volume:79 |g year:2024 |g day:06 |g month:04 |g pages:1-11 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.ajem.2024.01.039 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 79 |j 2024 |b 06 |c 04 |h 1-11 | ||