Skip to main content
SpringerLink
Log in

Pulmonary Embolism

  • Chapter
  • First Online:
Thoracic Surgery for the Acute Care Surgeon

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

Abstract

Pulmonary embolism (PE) is potentially life threatening and a common cause of morbidity and mortality that can constitute a thoracic emergency. The definitions, diagnosis, and treatment of this disease have evolved considerably over the last several decades warranting a careful review of the current state of its management. Because abundant, high-quality data is lacking for many of the management branch points, correct decision making around PE can be challenging. This chapter focuses on summarizing the state of the field with respect to diagnosis and treatment including relevant clinical studies and consensus opinion.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Silverstein MD, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. JAMA Intern Med. 1998;158(6):585–93.

    Article  CAS  Google Scholar 

  2. Tagalakis V, et al. Incidence of and Mortality from Venous Thromboembolism in a Real-world Population: The Q-VTE Study Cohort. Am J Med. 2013;126(9):832.e13–21.

    Article  Google Scholar 

  3. Sharifi M, et al. Pulseless electrical activity in pulmonary embolism treated with thrombolysis (from the “PEAPETT” study). Am J Emerg Med. 2016;34(10):1963–7.

    Article  Google Scholar 

  4. Jaff MR, et al. 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):1788–830.

    Article  Google Scholar 

  5. Kearon C, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315–52.

    Article  Google Scholar 

  6. Singh B, et al. Diagnostic accuracy of pulmonary embolism rule-out criteria: a systematic review and meta-analysis. Ann Emerg Med. 2012;59(6):517–520.e4.

    Article  Google Scholar 

  7. Wells PS, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998;129(12):997–1005.

    Article  CAS  Google Scholar 

  8. Klok FA, et al. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med. 2008;168(19):2131–6.

    Article  Google Scholar 

  9. Nagel SN, et al. Age-dependent diagnostic accuracy of clinical scoring systems and D-dimer levels in the diagnosis of pulmonary embolism with computed tomography pulmonary angiography (CTPA). Eur Radiol. 2019;29:4563–71.

    Article  Google Scholar 

  10. Cipolle MD, et al. The role of surveillance duplex scanning in preventing venous thromboembolism in trauma patients. J Trauma Acute Care Surg. 2002;52(3):453–62.

    Article  Google Scholar 

  11. PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990;263(20):2753.

    Article  Google Scholar 

  12. Stein PD, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators. Radiology. 2007;242(1):15–21.

    Article  Google Scholar 

  13. Moores L, et al. Pulmonary Embolism Severity Index and troponin testing for the selection of low-risk patients with acute symptomatic pulmonary embolism. J Thromb Haemost. 2010;8(3):517–22.

    Article  CAS  Google Scholar 

  14. Klok FA, Mos IC, Huisman MV. Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: a systematic review and meta-analysis. Am J Respir Crit Care Med. 2008;178(4):425–30.

    Article  Google Scholar 

  15. Sanchez O, et al. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J. 2008;29(12):1569–77.

    Article  Google Scholar 

  16. Barbar S, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450–7.

    Article  CAS  Google Scholar 

  17. Spyropoulos AC, et al. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest. 2011;140(3):706–14.

    Article  Google Scholar 

  18. Cronin M, et al. Completion of the updated Caprini risk assessment model (2013 version). Clin Appl Thromb Hemost. 2019;25:1076029619838052.

    Article  Google Scholar 

  19. Jiménez D, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with Acute Symptomatic Pulmonary Embolism Simplified Pulmonary Embolism Severity Index. JAMA Intern Med. 2010;170(15):1383–9.

    Article  Google Scholar 

  20. Robertson L, Jones LE. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for the initial treatment of venous thromboembolism. Cochrane Database Syst Rev. 2017;(2):CD001100.

    Google Scholar 

  21. Konstantinides SV, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) endorsed by the European Respiratory Society (ERS). Eur Heart J. 2014;35(43):3033–73.

    Article  CAS  Google Scholar 

  22. Groetzinger LM, et al. Apixaban or rivaroxaban versus warfarin for treatment of submassive pulmonary embolism after catheter-directed thrombolysis. Clin Appl Thromb Hemost. 2018;24(6):908–13.

    Article  CAS  Google Scholar 

  23. Kearon C, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2):e419S–96S.

    Article  CAS  Google Scholar 

  24. Konstantinides S, et al. Comparison of alteplase versus heparin for resolution of major pulmonary embolism. Am J Cardiol. 1998;82(8):966–70.

    Article  CAS  Google Scholar 

  25. Goldhaber SZ, et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet. 1993;341(8844):507–11.

    Article  CAS  Google Scholar 

  26. Meyer G, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med. 2014;370(15):1402–11.

    Article  CAS  Google Scholar 

  27. Wan S, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation. 2004;110(6):744–9.

    Article  CAS  Google Scholar 

  28. Chodakowski JD, Courtney DM. Pulmonary embolism critical care update: prognosis, treatment, and research gaps. Curr Opin Crit Care. 2018;24(6):540–6.

    Article  Google Scholar 

  29. Kline JA, et al. Randomized trial of inhaled nitric oxide to treat acute pulmonary embolism: the iNOPE trial. Am Heart J. 2017;186:100–10.

    Article  CAS  Google Scholar 

  30. Summerfield DT, et al. Inhaled nitric oxide as salvage therapy in massive pulmonary embolism: a case series. Respir Care. 2012;57(3):444–8.

    Article  Google Scholar 

  31. Piazza G, et al. A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study. J Am Coll Cardiol Intv. 2015;8(10):1382–92.

    Article  Google Scholar 

  32. Kuo WT, et al. Pulmonary embolism response to fragmentation, embolectomy, and catheter thrombolysis (PERFECT): initial results from a prospective multicenter registry. Chest. 2015;148(3):667–73.

    Article  Google Scholar 

  33. Rivera-Lebron B, et al. Diagnosis, treatment and follow up of acute pulmonary embolism: consensus practice from the PERT Consortium. Clin Appl Thromb Hemost. 2019;25:1076029619853037.

    Article  Google Scholar 

  34. Aymard T, et al. Massive pulmonary embolism: surgical embolectomy versus thrombolytic therapy—should surgical indications be revisited? Eur J Cardiothorac Surg. 2012;43(1):90–4.

    Article  Google Scholar 

  35. Azari A, et al. Surgical embolectomy versus thrombolytic therapy in the management of acute massive pulmonary embolism: short and long-term prognosis. Heart Lung. 2015;44(4):335–9.

    Article  Google Scholar 

  36. Rosovsky R, et al. Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis. J Thromb Thrombolysis. 2019;47(1):31–40.

    Article  Google Scholar 

  37. Pasrija C, et al. Triage and optimization: a new paradigm in the treatment of massive pulmonary embolism. J Thorac Cardiovasc Surg. 2018;156(2):672–81.

    Article  Google Scholar 

  38. Carroll BJ, et al. Clinical features and outcomes in adults with cardiogenic shock supported by extracorporeal membrane oxygenation. Am J Cardiol. 2015;116(10):1624–30.

    Article  Google Scholar 

  39. Geerts WH, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008;133(6):381S–453S.

    Article  CAS  Google Scholar 

  40. Geerts WH, et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med. 1996;335(10):701–7.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgical Critical Care Fellow, University of Washington, Washington, DC, USA

    David Miranda

  2. University of Washington, Washington, DC, USA

    Joseph Cuschieri

Authors
  1. David Miranda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph Cuschieri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph Cuschieri .

Editor information

Editors and Affiliations

  1. Davis Medical Centre, University of California, Davis, Sacramento, CA, USA

    Joseph M. Galante

  2. Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside, CA, USA

    Raul Coimbra

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Miranda, D., Cuschieri, J. (2021). Pulmonary Embolism. In: Galante, J.M., Coimbra, R. (eds) Thoracic Surgery for the Acute Care Surgeon. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-48493-4_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-48493-4_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48492-7

  • Online ISBN: 978-3-030-48493-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation