ICU SAQs · Respiratory / ventilation
Massive pulmonary embolism — thrombolysis and escalation
A CICM SAQ on massive PE — immediate systemic thrombolysis (alteplase 100 mg/2 h) on the echo diagnosis, heparin anticoagulation, surgical/catheter embolectomy, VA-ECMO; and the PEITHO evidence for the submassive PE.
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Prompt
A patient presents with a massive pulmonary embolism and hypotension (SBP 80 mmHg). The bedside echocardiogram shows right-ventricular dilatation and septal bowing. Outline the immediate management, including the role and evidence for thrombolysis, and the options if thrombolysis is contraindicated.
Question
A patient presents with a massive pulmonary embolism and hypotension (SBP 80 mmHg). The bedside echocardiogram shows right-ventricular dilatation and septal bowing. Outline the immediate management, including the role and evidence for thrombolysis, and the options if thrombolysis is contraindicated.
[1]References4ShowHide
- [1]Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. New England Journal of Medicine, 2014.PMID 24716681
- [3]Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. New England Journal of Medicine, 2002.PMID 12374874
- [4]Sharifi M, Bay C, Skrocki L, et al. Accelerated treatment with rtPA for pulmonary embolism induced circulatory arrest. Clinical Cardiology, 2021.PMID 33971387
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.