Treatment Not Anticoagulation

Management of Major or Submassive pulmonary embolism: [an acute episode

that causes hypoxia and mild hypotension (systolic arterial pressure >90 mm Hg),
but does not cause cardiac arrest or sustained low cardiac output and cardiogenic
shock]
Mechanical removal of pulmonary thrombi is possible by a catheter device
inserted under local anesthesia into the femoral (preferred) or jugular vein.
Successful extraction of clot with meaningful reduction in pulmonary arterial
pressure varies between 61 and 84%

Management of Acute Massive Pulmonary Embolism: If the circulation cannot be
stabilized at survival levels within several minutes or if cardiac arrest occurs after a
massive PE
Emergency pulmonary thromboembolectomy is indicated for suitable
patients with life-threatening circulatory insufficiency, but should not be done
w/o a definitive diagnosis bc a clinical diagnosis of PE is often wrong
o Can use TEE and color Doppler mapping in the OR to confirm or refute dx
of PE if a patient has been taken directly to the operating room without a
definitive diagnosis,
TEE will indicate increased right ventricular volume, poor right
ventricular contractility, and tricuspid regurgitation, which are
strongly associated with massive pulmonary embolism and acute
cor pulmonale.
Emergency Extracorporeal Life Support (ECLS) or Extracorporeal Life
Support (ELS) is indicated when surgery is not immediately available, in
patients who may not be surgical candidates, or in whom an alternate
diagnosis seems more likely. ECLS and ELS are performed using peripheral
cannulation via the femoral vessels, followed by heparin and need to for long-
term anticoagulation. Typically can be stopped within a few hours or 1-2 days.
o ECLS compensates for acute cor pulmonale and hypoxia and sustains the
circulation until the clot partially lyses, pulmonary vascular resistance
falls, and pulmonary blood flow becomes adequate.