The European Society of Cardiology (ESC) proposed several algorithms for patients with suspected pulmonary embolism. One algorithm relates to high-risk patients.
Patient selection: suspected PE with shock or hypotension (high risk)
Criteria for shock or hypotension:
(1) one of the following:
(1a) systolic blood pressure < 90 mm Hg for > 15 minutes
(1b) drop in systolic blood pressure >= 40 mm Hg for > 15 minutes
(2) exclusion of alternative explanation (new-onset arrhythmia, sepsis, hypovolemia)
Parameters:
(1) CT angiography immediately available
(2) right ventricular overload on echocardiography
Management options:
(1) PE-specific treatment with primary reperfusion
(2) search for other causes of hemodynamic instability
If CT angiography is immediately available and positive, then start PE-specific therapy.
If CT angiography is immediately available and negative, then search for other cause.
If CT angiography is not immediately available and RV overload is absent, then search for other causes.
If CT angiography is not immediately available and RV overload is present:
(1) start PE-specific therapy if no other tests available or if the patient is unstable
(2) start PE-specific therapy if CT angiography available and positive
(3) search for other cause if CT angiography available and negative
