Advanced Management of Intermediate-High Risk Pulmonary Embolism

Pulmonary embolism still represents a clinical conundrum in patients who are at increased risk of hemodynamic compromise but have not declared themselves unstable yet. This group of patients represents the intermediate-high risk patients who are both difficult to define and treat. While many patients would be adequately treated simply with anticoagulation some continue to progress; it is this progression that carries with it mortality risk. The treatment options, which vary from systemic anticoagulation, systemic thrombolysis, catheter-directed therapy, surgical management, and temporary cardiac support, with devices such as extracorporeal oxygenation, need to be carefully weighed against the risk of bleeding, especially intercranial hemorrhage. In this chapter, we discuss the pathophysiology of pulmonary embolism, the most common treatment modalities, and clinical predictors for decompensation. We address pulmonary embolism response teams and their role in the triage and medical decision making in these cases.