The following is a summary of “Management of high-risk pulmonary embolism in the emergency department: A narrative review,” published in the May 2024 issue of Emergency Medicine by Rouleau, et al.

For a study, researchers sought to equip emergency clinicians with a comprehensive understanding of managing high-risk pulmonary embolism (PE), focusing on systemic thrombolytics (ST) and other reperfusion therapies. The goal was to bridge the practice gap and align management with guideline recommendations for improved patient outcomes.

A thorough review was conducted to compile current evidence on high-risk PE management, emphasizing ST and alternative reperfusion strategies. The focus was addressing the disparity between guideline recommendations and clinical practice to enhance patient care.

Due to its life-threatening nature and dynamic pathophysiology, high-risk PE presents a critical challenge. Prompt identification and resuscitation are essential, including vasopressor administration and ensuring adequate oxygenation. Consensus guidelines advocate for ST as the primary reperfusion therapy, supported by evidence of efficacy. Surgical embolectomy and catheter-directed interventions are viable alternatives.

Emergency clinicians must comprehensively understand high-risk PE to manage patients effectively. Rapid recognition of hemodynamic instability and respiratory failure, coupled with prompt initiation of primary reperfusion therapies, is crucial for optimizing patient outcomes. Closing the gap between guideline recommendations and clinical practice was vital for improving the management of high-risk PE.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000524