title: Massive pulmonary embolism.
abstract: Massive pulmonary embolism (PE) is a potentially lethal condition, with death usually caused by right ventricular (RV) failure and cardiogenic shock. Systemic thrombolysis (unless contraindicated) is recommended as the first-line treatment of massive PE to decrease the thromboembolic burden on the RV and increase pulmonary perfusion. Surgical pulmonary embolectomy or catheter-directed thrombectomy should be considered in patients with contraindications to fibrinolysis, or those with persistent hemodynamic compromise or RV dysfunction despite fibrinolytic therapy. Critical care management predominantly involves supporting the RV, by optimizing preload, RV contractility, and coronary perfusion pressure and minimizing afterload. Despite these interventions, mortality remains high.
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, University of Cambridge, Cambridge CB23 3RE, UK. Electronic address: narain.moorjani@papworth.nhs.uk.
authors.forename: Narain
authors.initials: N
authors.lastname: Moorjani
authors.forename: Susanna
authors.initials: S
authors.lastname: Price
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D002404:Catheterization / Q000379:methods; D003422:Critical Care / Q000379:methods; D004452:Echocardiography / Q000379:methods; D017128:Embolectomy / Q000379:methods; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006353:Heart-Assist Devices; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D016306:Vena Cava Filters; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D
keywords: Anticoagulation; Pulmonary embolectomy; Pulmonary embolism; Right ventricular dysfunction; Thrombolysis