Understanding and treating pulmonary embolism in acute settings

Abstract

Background: High-risk pulmonary embolism (PE), encompassing a small but critical subset of cases, is associated with severe hemodynamic instability and high mortality rates. Representing 5–10% of all PE cases, high-risk PE is a leading cause of cardiovascular mortality, contributing to significant patient morbidity and mortality. Aim: This review aims to elucidate the management strategies and clinical approaches for high-risk PE, particularly in acute emergency settings. It seeks to provide a comprehensive overview of diagnostic and therapeutic strategies based on current guidelines. This review aimed to gain insights about treatment and management of PE via EMS and pharmacists. Methods: A thorough literature search was conducted using PubMed and Google Scholar, focusing on high-risk pulmonary embolism from the inception of these databases until October 1, 2023. The review included 147 articles comprising case reports, clinical trials, and systematic reviews. The search emphasized high-quality studies and guidelines, including those from the European Society of Cardiology (ESC) and the American Heart Association (AHA). Results: The review highlights the critical role of systemic thrombolytics (ST) in managing high-risk PE, despite their underutilization. It discusses the ESC and AHA guidelines for classifying PE risk and outlines the pathophysiology of right ventricular failure.