Release Date: 2024-03-21

Advanced Cardiac Life Support in Pulmonary Embolism

Sultan Tuna Akgol Gur (Author)

Release Date: 2024-03-21

Management of pulmonary embolism (PE) during resuscitation requires the rapid and effective handling of a serious and potentially life-threatening condition. Pulmonary embolism typically occurs when a clot from deep vein thrombosis in the legs reaches the pulmonary arteries, significantly impacting oxygenation and blood circulation. During resuscitation, the prompt diagnosis and management of PE are critical. [...]

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Work TypeBook Chapter
Published inSpecial Circumstances in Resuscitation
First Page129
Last Page144
DOIhttps://doi.org/10.69860/nobel.9786053358923.8
ISBN978-605-335-892-3 (PDF)
LanguageENG
Page Count16
Copyright HolderNobel Tıp Kitabevleri
Licensehttps://nobelpub.com/publish-with-us/copyright-and-licensing

Management of pulmonary embolism (PE) during resuscitation requires the rapid and effective handling of a serious and potentially life-threatening condition. Pulmonary embolism typically occurs when a clot from deep vein thrombosis in the legs reaches the pulmonary arteries, significantly impacting oxygenation and blood circulation.
During resuscitation, the prompt diagnosis and management of PE are critical. The first step is to evaluate the patient’s symptoms and clinical findings. Sudden shortness of breath, chest pain, tachycardia, and hypotension can suggest PE. In patients suspected of having PE, emergency imaging tests should be performed to confirm the diagnosis. Computed tomography (CT) pulmonary angiography is the most commonly used method for confirming PE.
Once PE is confirmed, the patient’s hemodynamic status is assessed. Hemodynamically unstable patients (presence of shock or hypotension) require immediate treatment. Thrombolytic therapy is used in these patients to rapidly dissolve the clot and can reduce mortality. However, thrombolytic therapy carries a risk of bleeding and should be administered cautiously.
In hemodynamically stable patients, anticoagulant therapy is initiated. Low molecular weight heparin (LMWH) or direct oral anticoagulants (DOAC) are generally preferred. These treatments prevent the clot from growing and reduce the risk of new clot formation. Additionally, it is important to identify and manage underlying risk factors to prevent PE. Conditions such as immobilization, cancer, or genetic clotting disorders should be addressed.
Management of PE during resuscitation requires a multidisciplinary approach. Collaboration among emergency medicine specialists, cardiologists, radiologists, and nurses ensures that the patient is treated quickly and effectively. Furthermore, after the patient is stabilized, a long-term follow-up and treatment plan should be established. In conclusion, the management of pulmonary embolism aims to reduce mortality and morbidity through rapid diagnosis and appropriate treatment strategies.

Sultan Tuna Akgol Gur (Author)
Associate Professor, Ataturk University
https://orcid.org/0000-0002-4490-7267
3Dr. Sultan Tuna AKGÖL GÜR is a successful medical specialist who has a long career and specializes in emergency medicine. She has made significant contributions through clinical practice, research and academic publications. She graduated from Atatürk University, Faculty of Medicine, Faculty of Medicine in 1999 and received his Emergency Medicine specialization from Atatürk University, Department of Emergency Medicine in 2012. She received the title of associate professor in 2021. He worked in many healthcare institutions, especially Health Sciences Hospitals. She currently works as an associate professor at the same institution. Atatürk University Department of Emergency Medicine. She made many oral and poster presentations at national and international conferences.

  • Heit JA. 2008. The epidemiology of venous thromboembolism in the community, Arterioscler Thromb Vasc Biol.

  • Pollack CV, Schreiber D, Goldhaber SZ, et al. 2011. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol 57: 700

  • Klok FA, van der Hulle T, den Exter PL, Lankeit M, Huisman MV, Konstantinides S. 2014.: The post-PE syndrome: a new concept for chronic complications of pulmonary embo¬lism. Blood Rev 28: 221.

  • A. Karalezli, 2018. Review, Pulmonary Embolism, Current Chest Diseases Series; 6(2):16-35)

  • Hess EP, Campbell RL, White RD.2007. Epidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin. Resuscitation 72, 200-206.

  • Deasy C, Bray JE, Smith K, Harriss LR, Bernard SA, Cameron P. 2011. Out-of-hospital cardiac arrests in young adults in Melbourne, Australia-adding coronial data to a cardiac arrest registry. Resuscitation; 82:1302-6.

  • Corrigan D, Prucnal C, Kabrhel C. 2016. Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients. Clin Exp Emerg Med; 3(3):117-125.)

  • McIntyre KM, Sasahara AA. 1971, The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease, Am J Cardiol, vol. 28 3(pg. 288-294)

  • Dirol H., Ozbudak O., 2016. Pulmonary Thromboembolism Physiopathology, Turkey Clinics J Pulm Med-Special Topics.;9(1):12-6

  • Piazza G, Goldhaber SZ., 2010, Venous thromboembolism and atherothrombosis: an integrated approach, Circulationvol. 121 19(pg. 2146-2150)

  • Severinsen MT, Kristensen SR, Johnsen SP, Dethlefsen C, Tjonneland A, 2009, Overvad K. Smoking and venous thromboembolism: a Danish follow-up study, J Thromb Haemost, vol. 7 8(pg. 1297-1303)

  • Steffen LM, Cushman M, Peacock JM, Heckbert SR, Jacobs DRJr., Rosamond WD, Folsom AR. 2009, Metabolic syndrome and risk of venous thromboembolism: Longitudinal Investigation of Thromboembolism Etiology, J Thromb Haemost, vol. 7 5(pg. 746-751)

  • Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW. 2008, Cardiovascular risk factors and venous thromboembolism: a meta-analysis, Circulation, vol. 117 1(pg. 93-102)

  • Coon WW, Willis PW. 1959; Deep venous thrombosis and pulmonary embolism: prediction, prevention and treatment. Am J Cardiol. 4:611.

  • Soloff LA, Rodman T. 1967; Acute pulmonary embolism. II. Clinical. Am Heart J. 74(6):829.

  • Ryu JH, Pellikka PA, Froehling DA, Peters SG, Aughenbaugh GL, 2007; Saddle pulmonary embolism diagnosed by CT angiography: frequency, clinical features and outcome. Respir Med.;101(7):1537. Epub 2007 Jan 24.

  • Sardi A, Gluskin J, Guttentag A, Kotler MN, Braitman LE, Lippmann M. 2011, Saddle pulmonary embolism: is it as bad as it looks? A community hospital experience. Crit Care Med. Nov;39(11):2413-8.

  • PIOPED 1990; Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 263:2753.

  • Stein PD, Terrin ML, Hales CA, et al. 1991, Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest; 100:598.

  • Stein PD, Beemath A, Matta F, et al, 2007. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med; 120:871.

  • Stein PD, Saltzman HA, Weg JG. 1991; Clinical characteristics of patients with acute pulmonary embolism. Am J Cardiol; 68:1723.

  • Liesching T, Brien O, 2002; A. Significance of a syncopal event. Pulmonary embolism. Postgrad Med .111:19.

  • Castelli R, Tarsia P, Tantardini C, et al. 2003; Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope. Vasc Med 8:257.

  • Coen M, Leuchter I, Sussetto M, et al. 2018; Progressive Dysphonia: Ortner Syndrome. Am J Med; 131:e494.

  • Kline JA, Corredor DM, Hogg MM, Hernandez J, Jones AE. 2012: Normalization of vital signs does not reduce the probability of acute pulmonary embolism in symptomatic emergency department patients. Acad Emerg Med 19: 11.

  • Kline JA, Neumann D, Hall CL, Capito J., 2017; Role of physician perception of patient smile on pretest probability assessment for acute pulmonary embolism. Emerg Med J 34: 82, [PMID: 27485261]

  • Wells P.S., Anderson D.R., Rodgers M., Ginsberg J.S., Kearon C., Gent M., Turpie A.G.G., Bormanis J., Weitz J., Chamberlain M., Bowie D., Barbes D., Hirsh J., 2000, Derivation of a simple clinical model to categorize patients’ probability of pulmonary embolism: increasing the model’s utility with simpli RED D‐dimer Thromb Haemost, 83, pp. 416-20

  • Wicki J., Perneger T.V., Junod A.F., Bounameaux H., Perrier A., 2001; Assessing clinical probability of pulmonary embolism in the emergency ward, Arch Intern Med, 161, pp. 92-7

  • Ten Cate‐Hoek A.J., Prins M.H., 2005, Management studies using a combination of D‐dimer test result and clinical probability to rule out venous thromboembolism: a systematic review, J Thromb Haemost, 3 pp. 2465-70

  • Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. 2004; Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2:1247-55.

  • Rodger MA, Carrier M, Jones GN, et al. 2000; Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism. Am J Respir Crit Care Med; 162:2105.

  • Söhne M, Ten Wolde M, Boomsma F, et al. 2006; Brain natriuretic peptide in hemodynamically stable acute pulmonary embolism. J Thromb Haemost; 4:552.

  • Kiely DG, Kennedy NS, Pirzada O, et al.2005; Elevated levels of natriuretic peptides in patients with pulmonary thromboembolism. Respir Med 2005; 99:1286.

  • Henzler T, Roeger S, Meyer M, et al. 2012, Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction. Eur Respir J ; 39(4):919-926.

  • Klok FA, Mos IC, Huisman MV. 2008, Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: a systematic review and meta-analysis. Am J Respir Crit Care Med ;178 (4):425-430.

  • Meyer T, Binder L, Hruska N, et al. 2000, Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol; 36:1632.

  • Giannitsis E, Müller-Bardorff M, Kurowski V, et al. 2000, Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation; 102:211.

  • Konstantinides S, Geibel A, Olschewski M, et al. 2002; Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation; 106:1263.

  • Douketis JD, Crowther MA, Stanton EB, Ginsberg JS. 2002; Elevated cardiac troponin levels in patients with submassive pulmonary embolism. Arch Intern Med; 162:79.

  • Horlander KT, Leeper KV. 2003; Troponin levels as a guide to treatment of pulmonary embolism. Curr Opin Pulm Med 2003; 9:374.

  • Di Nisio M, Squizzato A, Rutjes AW, Büller HR, Zwinderman AH, Bossuyt PM. 2007; Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review, J Thromb Haemost, vol. 5 2(pg. 296-304)

  • Geibel A, Zehender M, Kasper W, et al.2005; Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. Eur Respir J; 25:843.

  • Rodger M, Makropoulos D, Turek M, et al.2000; Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol; 86:807.

  • Co I, Eilbert W, Chiganos T. 2017; New Electrocardiographic Changes in Patients Diagnosed with Pulmonary Embolism. J Emerg Med; 52:280.

  • Ferrari E, Imbert A, Chevalier T, et al.1997; The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads 80 case reports. Chest; 111:537.

  • Shopp JD, Stewart LK, Emmett TW, Kline JA.

  • 2015; Findings From 12-lead Electrocardiography That Predict Circulatory Shock From Pulmonary Embolism: Systematic Review and Meta-analysis. Acad Emerg Med; 22:1127.

  • Panos RJ, Barish RA, Whye DW Jr, Groleau G. 1988; The electrocardiographic manifestations of pulmonary embolism. J Emerg Med; 6:301.

  • Van Es J, Douma RA, Schreuder SM, et al 2013: Clinical impact of findings supporting an alternative diagnosis on CT pulmonary angiography in patients with suspected pulmo-nary embolism. Chest 144: 1893, [PMID: 23989896]

  • Worsley DF, Alavi A, Aronchick JM, et al. 1993; Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology; 189:133.

  • Celebioglu E.,Ozgen Kıratlı M.P., Cöplü L. 2015; Ventilation/Perfusion Scintigraphy in Pulmonary Embolism

  • Turkiye Klinikleri J Cardiol-Special Topics. 2015;8(6):37-41

  • Cossette B, Pelletier ME, Carrier N, Turgeon M, Leclair C, Charron P, Echenberg D, Fayad T, Farand P. 2010, Evaluation of bleeding risk in patients exposed to therapeutic unfractionated or low-molecular-weight heparin: a cohort study in the context of a quality improvement initiative, Ann Pharmacother, vol. 44 6(pg. 994-1002)

  • Prandoni P, Siragusa S, Girolami B, Fabris F. 2005; The incidence of heparin-induced thrombocytopenia in medical patients treated with low-molecular-weight heparin: a prospective cohort study, Blood, vol. 106 9(pg. 3049-3054)

  • Raschke RA, Golihare B, Peirce JC. 1996; Effectiveness of applying the weight-based heparin nomogram as a practice guide, Arch Intern Med, vol.156 15(pg. 1645-1649)

  • Position Paper of the ESC Thrombosis Working Group – 2013, Working Group on Anticoagulants in Heart Disease, Thromb Haemost, vol. 110 6(pp. 1087-1107)

  • Heidbuchel H, Verhamme P, Alingler M, Antz M, Hacke K, Eskigren J, Sinnaeve P, Camm AJ, Kirchhof P., 2013, EHRA practical guidance on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary, Eur Heart J, vol.34 27(pg. 2094-2106)

  • Meneveau N, Seronde M, Blonde M, et al. 2006; Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest;129:1043-50.

  • Daniels LB, Parker JA, Patel SR, et al. 1997; Relation of duration of symptoms with response to thrombolytic therapy in pulmonary embolism. Am J Cardiol; 80: 184-8.

  • Kearon C, Kahn SR, Agnelli K, et al, 2008;. Antithrombotic therapy for venous thromboembolic disease. ACCP evidence based clinical practice guidelines (8th Edition). Chest 133:454-545.

  • Konstantinides 2008; S. Acute pulmonary embolism. N. Eng JMed 2008: 359; 2804-13.

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