Skip to main content

Pulmonary Embolism in the Multiple Trauma Patient

PERT Consortium Handbook of Pulmonary Embolism
  • 59 Accesses

Abstract

While peri-traumatic pulmonary embolism (PE) is rare, its occurrence has significant short- and long-term implications for the patient’s care. The diagnosis, management, and outcomes following peri-traumatic PE are discussed, with specific attention paid to circumstances that differentiate it from non-traumatic PE. Bleeding risk is a major consideration when managing a polytrauma patient who has suffered a clinically significant PE. As such, the history and current use of prophylactic inferior vena cava filters are evaluated. Fat emboli syndrome, a related entity, is also described in detail.

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

Access this chapter

Institutional subscriptions

Similar content being viewed by others

References

  • Albrecht JS, Liu X, Baumgarten M, Langenberg P, Rattinger GB, Smith GS, Gambert SR, Gottlieb SS, Zuckerman IH. Benefits and risks of anticoagulation resumption following traumatic brain injury. JAMA Intern Med. 2014;174(8):1244–51.

    Article  PubMed  PubMed Central  Google Scholar 

  • Allardyce DB, Meek RN, Woodruff B, Cassim M, Ellis D. Increasing our knowledge of the pathogenesis of fat embolism. J Trauma. 1974;14(11):955–62.

    Article  CAS  PubMed  Google Scholar 

  • Bahloul M, Regaieg K, Chtara K, Turki O, Baccouch N, Chaari A, Bouaziz M. Post-traumatic thromboembolic complications: incidence, risk factors, pathophysiology, and prevention. Ann Cardiol Angeiol. 2017;66:92–101.

    Article  CAS  Google Scholar 

  • Bahloul M, Dlela M, Bouchaala K, Triki A, Chelly H, Ben Hamida C, Haddar S, Bouaziz M. Early post-traumatic pulmonary embolism in intensive care unit: incidence, risks factors, and impact outcome. Am J Cardiovasc Dis. 2020;10:207–18.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Benns M, Reilly P, Kim P. Early pulmonary embolism after injury: a different clinical entity? Injury. 2014;45:241–4.

    Article  PubMed  Google Scholar 

  • Brakenridge SC, Toomay SM, Sheng JL, Gentilello LM, Shafi S. Predictors of early versus late timing of pulmonary embolus after traumatic injury. Am J Surg. 2011;201:209–15.

    Article  PubMed  Google Scholar 

  • Carr JB, Hansen ST. Fulminant fat embolism. Orthopedics. 1990;13(2):258–61.

    Article  CAS  PubMed  Google Scholar 

  • Coleman JJ, Zarzaur BL, Katona CW, Plummer ZJ, Johnson LS, Fecher A, O’Rear JM, Feliciano DV, Rozycki GS. Factors associated with pulmonary embolism within 72 hours of admission after trauma: a multicenter study. J Am Coll Surg. 2015;220:731–6.

    Article  PubMed  Google Scholar 

  • Gaitanidis A, Breen KA, Nederpelt C, Parks J, Saillant N, Kaafarani H, Velmahos G, Mendoza A. Timing of thromboprophylaxis in patients with blunt abdominal solid organ injuries undergoing nonoperative management. J Trauma Acute Care Surg. 2021;90:148–56.3.

    Article  CAS  PubMed  Google Scholar 

  • Gelbard RB, Karamanos E, Farhoomand A, Keeling WB, McDaniel MC, Wyrzykowski AD, Shafii MS, Rajani RR. Immediate post-traumatic pulmonary embolism is not associated with right ventricular dysfunction. Am J Surg. 2016;212:769–74.

    Article  PubMed  Google Scholar 

  • Girard TD, Philbrick JT, Fritz Angle J, Becker DM. Prophylactic vena cava filters for trauma patients: a systematic review of the literature. Thromb Res. 2003;112(5–6):261–7.

    Article  CAS  PubMed  Google Scholar 

  • Greenfield LJ, Proctor MC. Recurrent thromboembolism in patients with vena cava filters. J Vasc Surg. 2001;33:510–4.

    Article  CAS  PubMed  Google Scholar 

  • Gupta A, Reilly CS. Fat embolism. Contin Educ Anaesth Crit Care Pain. 2007;7(5):148–51.

    Article  Google Scholar 

  • Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br. 1974;56B:408–16.

    Article  CAS  PubMed  Google Scholar 

  • Habashi NM, Andrews PL, Scalea TM. Therapeutic aspects of fat embolism syndrome. Injury. 2006;37(Suppl 4):S68–73.

    Article  PubMed  Google Scholar 

  • Hoffman H, Jalal MS, Chin LS. The risk factors, outcomes, and costs associated with venous thromboembolism after traumatic brain injury: a nationwide analysis. Brain Inj. 2019;33:1671–8.

    Article  PubMed  Google Scholar 

  • Hulman G. The pathogenesis of fat embolism. J Pathol. 1995;176:3–9.

    Article  CAS  PubMed  Google Scholar 

  • Johnson MJ, Lucas GL. Fat embolism syndrome. Orthopedics. 1996;19:41.

    Article  CAS  PubMed  Google Scholar 

  • Kaplan RP, Grant JN, Kaufman AJ. Dermatologic features of the fat embolism syndrome. Cutis. 1986;38:52–5.

    CAS  PubMed  Google Scholar 

  • Kaufman JA, et al. Society of Interventional Radiology clinical practice guideline for inferior vena cava filters in the treatment of patients with venous thromboembolic disease. J Vasc Interv Radiol. 2020;31(10):1529–44.

    Article  PubMed  Google Scholar 

  • Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores L. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315–52.

    Article  PubMed  Google Scholar 

  • King MB, Harmon KR. Unusual forms of pulmonary embolism. Clin Chest Med. 1994;15:561–80.

    Article  CAS  PubMed  Google Scholar 

  • Knudson MM, Ikossi DG, Khaw L, Morabito D, Speetzen LS. Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank. Ann Surg. 2004;240:490–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kwok AM, Davis JW, Dirks RC, Wolfe MM, Kaups KL. Time is now: venous thromboembolism prophylaxis in blunt splenic injury. Am J Surg. 2016;212:1231–6.

    Article  PubMed  Google Scholar 

  • Lichte P, Kobbe P, Almahmoud K, Pfeifer R, Andruszkow H, Hildebrand F, Lefering R, Pape HC, Trauma Register DGU. Post-traumatic thrombo-embolic complications in polytrauma patients. Int Orthop. 2015;39:947–54.

    Article  PubMed  Google Scholar 

  • Liou DZ, Shafi H, Bloom MB, Chung R, Ley EJ, Salim A, Tcherniantchouk O, Margulies DR. Defining early trauma-induced coagulopathy using thromboelastography. Am Surg. 2014;80:994–8.

    Article  PubMed  Google Scholar 

  • Martin G, Pugh A, Williams SG, Hanseman D, Nomellini V, Makley A, Pritts TA, Goodman MD. Lower extremity duplex ultrasound screening protocol for moderate- and high-risk trauma patients. J Surg Res. 2019;235:280–7.

    Article  PubMed  Google Scholar 

  • McCartney JS. Pulmonary embolism following trauma. Am J Pathol. 1934;10:709–10.

    Google Scholar 

  • Mellor A, Soni N. Fat embolism. Anaesthesia. 2001;56:145–54.

    Article  CAS  PubMed  Google Scholar 

  • Menaker J, Stein DM, Scalea TM. Incidence of early pulmonary embolism after injury. J Trauma. 2007;63:620–4.

    PubMed  Google Scholar 

  • Menaker J, Stein DM, Scalea TM. Pulmonary embolism after injury: more common than we think? J Trauma. 2009;67:1244–9.

    PubMed  Google Scholar 

  • Murray JL, Keeling WB. Surgical thrombectomy (TBD – this textbook, different chapter). n.d.

    Google Scholar 

  • Pell AC, Christie J, Keating JF, Sutherland GR. The detection of fat embolism by transoesophageal echocardiography during reamed intramedullary nailing: a study of 24 patients with femoral and tibial fractures. J Bone Joint Surg Br. 1993;75:921–5.

    Article  CAS  PubMed  Google Scholar 

  • Pruszczyk P, Goliszek S, Lichodziejewska B, Kostrubiec M, CiurzyÅ„ski M, Kurnicka M, Dzikowska-Diduch O, Palczewski P, Wyzgal A. Prognostic value of echocardiography in normotensive patients with acute pulmonary embolism. JACC Cardiovasc Imaging. 2014;7(6):553–60.

    Article  PubMed  Google Scholar 

  • Rogers FB, Cipolle MD, Velmahos G, Rozycki G, Luchette FA. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST Practice Management Guidelines Work Group. J Trauma. 2002;53(1):142–64.

    Article  PubMed  Google Scholar 

  • Ruskin KJ. Deep vein thrombosis and venous thromboembolism in trauma. Curr Opin Anaesthesiol. 2018;3:215–8.

    Article  Google Scholar 

  • Saeed MJ, Turner TE, Brown DL. Trends in inferior vena cava filter placement by indication in the United States from 2005 to 2014. JAMA Intern Med. 2017;177:1861–2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Scales DC, Riva-Cambrin J, Wells D, Athaide V, Granton JT, Detsky AS. Prophylactic anticoagulation to prevent venous thromboembolism in traumatic intracranial hemorrhage: a decision analysis. Crit Care. 2010;14:R72.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schaible EV, Thal SC. Anticoagulation in patients with traumatic brain injury. Curr Opin Anaesthesiol. 2013;26:529–34.

    Article  CAS  PubMed  Google Scholar 

  • Schellenberg M, Inaba K, Biswas S, Heindel P, Benjamin E, Strumwasser A, Matsushima K, Lam L, Demetriades D. When is it safe to start VTE prophylaxis after blunt solid organ injury? A prospective study from a level I trauma center. World J Surg. 2019;43(11):2797–803.

    Article  PubMed  Google Scholar 

  • Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, Jacob HS. Fat embolism prophylaxis with corticosteroids: a prospective study in high-risk patients. Ann Intern Med. 1983;99:438–43.

    Article  CAS  PubMed  Google Scholar 

  • Schreiber MA, Differding J, Thorborg P, Mayberry JC, Mullins RJ. Hypercoagulability is most prevalent early after injury and in female patients. J Trauma. 2005;58:475–81.

    Article  PubMed  Google Scholar 

  • Shaz BH, Winkler AM, James AB, Hillyer CD, MacLeod JB. Pathophysiology of early trauma induced coagulopathy: emerging evidence for hemodilution and coagulation factor depletion. J Trauma. 2011;70:1401–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Shuster R, Mathew J, Olaussen A, Gantner D, Varma D, Koukounaras J, Fitzgerald MC, Cameron PA, Mitra B. Variables associated with pulmonary thromboembolism in injured patients: a systematic review. Injury. 2018;49:1–7.

    Article  PubMed  Google Scholar 

  • Van den Brande FGJ, Hellemans S, De Schepper A. Post-traumatic severe fat embolism syndrome with uncommon CT findings. Anaesth Intensive Care. 2006;34:102–6.

    Article  PubMed  Google Scholar 

  • Van Gent JM, Calvo RY, Zander AL, Olson EJ, Sise CB, Sise MJ, Shackford SR. Risk factors for deep vein thrombosis and pulmonary embolism after traumatic injury: a competing risks analysis. J Trauma Acute Care Surg. 2017;83(6):1154–60.

    Article  PubMed  Google Scholar 

  • Velmahos GC, Kern J, Chan L, et al. Prevention of venous thromboembolism after trauma: an evidence-based report – part II: analysis of risk factors and evaluation of the role of vena cava filters. J Trauma. 2000;49:140–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ravi R. Rajani .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2023 PERT

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Cavallo, G., Rajani, R.R. (2023). Pulmonary Embolism in the Multiple Trauma Patient. In: Grodzin, C.J., Merli, G.J., Ross, C.B., Rosovsky, R. (eds) PERT Consortium Handbook of Pulmonary Embolism . Springer, Cham. https://doi.org/10.1007/978-3-030-70904-4_28-2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-70904-4_28-2

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-70904-4

  • Online ISBN: 978-3-030-70904-4

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Pulmonary Embolism in the Multiple Trauma Patient
    Published:
    26 August 2023

    DOI: https://doi.org/10.1007/978-3-030-70904-4_28-3

  2. Original

    Pulmonary Embolism in the Multiple Trauma Patient
    Published:
    15 February 2023

    DOI: https://doi.org/10.1007/978-3-030-70904-4_28-2