(Originally presented by Dr Ivy Park)
Definition
Acute Pulmonary Embolism with:
- Sustained hypotension > 15 minutes (SBP<90mmHg or <40mmHg from baseline)
- OR
- Inotropic requirement
Mortality
30 day mortality > 30% without re-perfusion
Diagnosis
- CTPA (Gold standard)
- Challenging for unstable patients
- TTE (Suggestive features)
- New RV strain
- Increased RV size
- Direct visualisation of thrombus
Treatment may be initiated based upon presumptive diagnosis in unstable patients
Treatment
PE Response Team undertakes MDT approach with consideration of:
- Interventional Radiology
- Systemic thrombolysis
- Unfractionated heparin
- Surgical embolectomy
Supportive treatment includes:
- Preload optimisation
- Inotropic / vasopressor support
- Pulmonary vasodilatation
- VA ECMO
Current evidence and recommendation
- No high quality evidence to support one treatment over the other
- MDT approach to determine risk/benefits of available treatment options
- Thrombolysis
- Alteplase 1.5mg/kg- 10mg bolus then remainder over 2 hour
- Ideal dose unknown. Some papers describe similar efficacy at lower doses
Example PE Response Team Protocol
![](https://sghanaesthesiaeducation.wordpress.com/wp-content/uploads/2021/05/image.png?w=688)
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