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High and intermediate risk pulmonary embolism in the ICU

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Abstract

Pulmonary embolism (PE) is a common and important medical emergency, encountered by clinicians across all acute care specialties. PE is a relatively uncommon cause of direct admission to the intensive care unit (ICU), but these patients are at high risk of death. More commonly, patients admitted to ICU develop PE as a complication of an unrelated acute illness. This paper reviews the epidemiology, diagnosis, risk stratification, and particularly the management of PE from a critical care perspective. Issues around prevention, anticoagulation, fibrinolysis, catheter-based techniques, surgical embolectomy, and extracorporeal support are discussed.

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Authors and Affiliations

  1. Critical Care, The University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada

    Scott J. Millington

  2. Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre & Université Paris Cité, Paris, France

    Nadia Aissaoui

  3. Department of Intensive Care, Nepean Hospital, University of Sydney, Sydney, Australia

    Emma Bowcock

  4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Daniel Brodie

  5. Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada

    Karine E. A. Burns & Ghislaine Douflé

  6. Li Ka Shing Knowledge Institute, Unity Health Toronto–St. Michael’s Hospital, Toronto, Canada

    Karine E. A. Burns

  7. Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada

    Ghislaine Douflé

  8. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

    François Haddad

  9. Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA

    François Haddad

  10. Vera Moulton Wall Center for Pulmonary Vascular Disease at Stanford University, Stanford, CA, USA

    François Haddad

  11. Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado, Rocky Mountain Regional VA Medical Center, Denver, CO, USA

    Tim Lahm

  12. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Gregory Piazza

  13. Service de pneumologie et soins intensifs, Hopital Européen Georges Pompidou, APHP, Paris, France

    Olivier Sanchez

  14. INSERM UMR S 1140, Innovative Therapies in Hemostasis, Université Paris Cité, Paris, France

    Olivier Sanchez

  15. Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France

    Laurent Savale

  16. INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France

    Laurent Savale

  17. Medical and Surgical ICU, University Hospital Ambroise Pare, GHU Paris-Saclay, APHP, Boulogne-Billancourt, France

    Antoine Vieillard-Baron

  18. Inserm U1018, CESP, Universite Versailles Saint-Quentin en Yvelines, Guyancourt, France

    Antoine Vieillard-Baron

Authors
  1. Scott J. Millington
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  2. Nadia Aissaoui
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  3. Emma Bowcock
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  4. Daniel Brodie
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  5. Karine E. A. Burns
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  6. Ghislaine Douflé
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  7. François Haddad
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  8. Tim Lahm
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  9. Gregory Piazza
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  10. Olivier Sanchez
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  11. Laurent Savale
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  12. Antoine Vieillard-Baron
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Corresponding author

Correspondence to Antoine Vieillard-Baron.

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Conflicts of interest

DB receives research support from and consults for LivaNova. He has been on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira and Cellenkos. He is the President-elect of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Executive Committee of the International ECMO Network (ECMONet), and he writes for UpToDate. FH receives NIH and industry support for research, but none related to this paper. TL receives support from the NIH, Department of Veterans Affairs, and Borstein Family Foundation, but none related to this paper. GP received research grants from BMS/Pfizer, Janssen, Alexion, Bayer, Amgen, BSC, and Esperion, and has advisory roles for BSC, Amgen, BCRI, PERC, NAMSA, BMS, Janssen, and Regeneron. LS reports personal fees from Janssen and Janssen and MSD not related to this paper. AVB received fees from Air Liquide healthcare as a medical advisory board member for conducting clinical research on NO inhalation in COVID-19. The remainder of authors declare no relevant conflicts of interest.

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Millington, S.J., Aissaoui, N., Bowcock, E. et al. High and intermediate risk pulmonary embolism in the ICU. Intensive Care Med 50, 195–208 (2024). https://doi.org/10.1007/s00134-023-07275-6

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