Pulmonary embolism is a potentially lethal manifestation of venous thromboembolic disease. It is one of the three main causes of cardiovascular morbidity and mortality in developed countries. Over the years, better diagnostic and risk stratification measures were implemented. A generous range of new treatment options is becoming available, particularly for management of massive pulmonary embolism. Nonetheless, clinicians often face uncertainty in clinical practice due to lack of scientific support for available treatment options. The aim of this article is to review management of massive pulmonary embolism.

Department of Cardiology 2nd Medical School Charles University Motol University Hospital Prague Czech Republic

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Smith S B, Geske J B, Kathuria P. Analysis of national trends in admissions for pulmonary embolism. Chest. 2016;150(01):35–45. PubMed PMC

Raskob G E, Angchaisuksiri P, Blanco A N. Thrombosis: a major contributor to global disease burden. J Thromb Haemost. 2014;12(10):1580–1590. PubMed

ESC Scientific Document Group . Konstantinides S V, Meyer G, Becattini C. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS) Eur Heart J. 2020;41 04:543–603. PubMed

Wood K E.Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism Chest 2002121(3, suppl):877–905. PubMed

PERT Consortium . Rivera-Lebron B, McDaniel M, Ahrar K. Diagnosis, treatment and follow up of acute pulmonary embolism: consensus practice from the PERT Consortium. Clin Appl Thromb Hemost. 2019;25:1.076029619853037E15. PubMed PMC

American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation ; American Heart Association Council on Peripheral Vascular Disease ; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology . Jaff M R, McMurtry M S, Archer S L. 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):1788–1830. PubMed

Smith S B, Geske J B, Maguire J M, Zane N A, Carter R E, Morgenthaler T I. Early anticoagulation is associated with reduced mortality for acute pulmonary embolism. Chest. 2010;137(06):1382–1390. PubMed PMC

Bhat T, Neuman A, Tantary M. Inhaled nitric oxide in acute pulmonary embolism: a systematic review. Rev Cardiovasc Med. 2015;16(01):1–8. PubMed

Ventetuolo C E, Klinger J R. Management of acute right ventricular failure in the intensive care unit. Ann Am Thorac Soc. 2014;11(05):811–822. PubMed PMC

Lyhne M D, Dragsbaek S J, Hansen J V, Schultz J G, Andersen A, Nielsen-Kudsk J E.Levosimendan, milrinone, and dobutamine in experimental acute pulmonary embolismPulm Circ 2021;11(03):20458940211022977 PubMed PMC

Stevens S M, Woller S C, Kreuziger L B. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021;160(06):e545–e608. PubMed

Goldhaber S Z, Haire W D, Feldstein M L.Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion Lancet 1993341(8844):507–511. PubMed

Konstantinides S, Tiede N, Geibel A, Olschewski M, Just H, Kasper W. Comparison of alteplase versus heparin for resolution of major pulmonary embolism. Am J Cardiol. 1998;82(08):966–970. PubMed

Daniels L B, Parker J A, Patel S R, Grodstein F, Goldhaber S Z. Relation of duration of symptoms with response to thrombolytic therapy in pulmonary embolism. Am J Cardiol. 1997;80(02):184–188. PubMed

Tapson V F. Acute pulmonary embolism. N Engl J Med. 2008;358(10):1037–1052. PubMed

McFadden P M, Ochsner J L. Aggressive approach to pulmonary embolectomy for massive acute pulmonary embolism: a historical and contemporary perspective. Mayo Clin Proc. 2010;85(09):782–784. PubMed PMC

Goldberg J B, Spevack D M, Ahsan S. Survival and right ventricular function after surgical management of acute pulmonary embolism. J Am Coll Cardiol. 2020;76(08):903–911. PubMed

Pasrija C, Kronfli A, Rouse M. Outcomes after surgical pulmonary embolectomy for acute submassive and massive pulmonary embolism: A single-center experience. J Thorac Cardiovasc Surg. 2018;155(03):1095–110600. PubMed

Neely R C, Byrne J G, Gosev I. Surgical embolectomy for acute massive and submassive pulmonary embolism in a series of 115 patients. Ann Thorac Surg. 2015;100(04):1245–1252. PubMed

Giri J, Sista A K, Weinberg I. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the american heart association. Circulation. 2019;140(20):e774–e801. PubMed

Teleb M, Porres-Aguilar M, Rivera-Lebron B. Ultrasound-assisted catheter-directed thrombolysis: a novel and promising endovascular therapeutic modality for intermediate-risk pulmonary embolism. Angiology. 2017;68(06):494–501. PubMed

SUNSET sPE Collaborators . Avgerinos E D, Jaber W, Lacomis J. Randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism: the SUNSET sPE Trial. JACC Cardiovasc Interv. 2021;14(12):1364–1373. PubMed PMC

Sista A K. Is it time to sunset ultrasound-assisted catheter-directed thrombolysis for submassive PE? JACC Cardiovasc Interv. 2021;14(12):1374–1375. PubMed

Aso S, Matsui H, Fushimi K, Yasunaga H. In-hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5,263 patients using a national inpatient database in Japan. Crit Care. 2016;20(01):80. PubMed PMC

Yusuff H O, Zochios V, Vuylsteke A. Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a systematic review. Perfusion. 2015;30(08):611–616. PubMed

Meneveau N, Guillon B, Planquette B. Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases. Eur Heart J. 2018;39(47):4196–4204. PubMed

George B, Parazino M, Omar H R. A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support. Resuscitation. 2018;122:1–5. PubMed

Ghoreishi M, DiChiacchio L, Pasrija C. Predictors of recovery in patients supported with venoarterial extracorporeal membrane oxygenation for acute massive pulmonary embolism. Ann Thorac Surg. 2020;110(01):70–75. PubMed

Kapur N K, Esposito M L, Bader Y. Mechanical circulatory support devices for acute right ventricular failure. Circulation. 2017;136(03):314–326. PubMed

Porres-Aguilar M, Anaya-Ayala J E, Jiménez D, Mukherjee D. Pulmonary embolism response teams: pursuing excellence in the care for venous thromboembolism. Arch Med Res. 2019;50(05):257–258. PubMed