Abstract：
High-risk pulmonary embolism (PE) is a complex, life-threatening condition, and emergency clinicians must be ready to resuscitate and rapidly pursue primary reperfusion therapy. The first-line reperfusion therapy for patients with high-risk PE is systemic thrombolytics (ST). Despite consensus guidelines, only a fraction of eligible patients receive ST for high-risk PE.
This review provides emergency clinicians with a comprehensive overview of the current evidence regarding the management of high-risk PE with an emphasis on ST and other reperfusion therapies to address the gap between practice and guideline recommendations.
High-risk PE is defined as PE that causes hemodynamic instability. The high mortality rate and dynamic pathophysiology of high-risk PE make it challenging to manage. Initial stabilization of the decompensating patient includes vasopressor administration and supplemental oxygen or high-flow nasal cannula. Primary reperfusion therapy should be pursued for those with high-risk PE, and consensus guidelines recommend the use of ST for high-risk PE based on studies demonstrating benefit. Other options for reperfusion include surgical embolectomy and catheter directed interventions.
Emergency clinicians must possess an understanding of high-risk PE including the clinical assessment, pathophysiology, management of hemodynamic instability and respiratory failure, and primary reperfusion therapies.
This review provides emergency clinicians with a comprehensive overview of the current evidence regarding the management of high-risk PE with an emphasis on ST and other reperfusion therapies to address the gap between practice and guideline recommendations.
High-risk PE is defined as PE that causes hemodynamic instability. The high mortality rate and dynamic pathophysiology of high-risk PE make it challenging to manage. Initial stabilization of the decompensating patient includes vasopressor administration and supplemental oxygen or high-flow nasal cannula. Primary reperfusion therapy should be pursued for those with high-risk PE, and consensus guidelines recommend the use of ST for high-risk PE based on studies demonstrating benefit. Other options for reperfusion include surgical embolectomy and catheter directed interventions.
Emergency clinicians must possess an understanding of high-risk PE including the clinical assessment, pathophysiology, management of hemodynamic instability and respiratory failure, and primary reperfusion therapies.
摘要：
背景：高危肺栓塞（PE）是一种复杂的，危及生命的状况,急诊临床医生必须准备好复苏并迅速进行初级再灌注治疗。高危PE患者的一线再灌注治疗是全身性溶栓（ST）。尽管有共识的指导方针，只有一小部分符合条件的患者接受高危PE的ST.
目的：本综述为急诊临床医生提供了有关高危PE管理的现有证据的全面概述，重点是ST和其他再灌注疗法，以解决实践与指南建议之间的差距。
结论：高危PE定义为导致血流动力学不稳定的PE。高危PE的高死亡率和动态病理生理学使其管理具有挑战性。失代偿患者的初始稳定包括血管升压药施用和补充氧气或高流量鼻插管。对于高危PE患者，应进行初级再灌注治疗，和共识指南基于证明获益的研究推荐将ST用于高危PE.再灌注的其他选择包括外科栓塞切除术和导管定向介入。
结论：急诊临床医生必须了解高危PE，包括临床评估，病理生理学,血流动力学不稳定和呼吸衰竭的管理，和初级再灌注疗法。
目的：本综述为急诊临床医生提供了有关高危PE管理的现有证据的全面概述，重点是ST和其他再灌注疗法，以解决实践与指南建议之间的差距。
结论：高危PE定义为导致血流动力学不稳定的PE。高危PE的高死亡率和动态病理生理学使其管理具有挑战性。失代偿患者的初始稳定包括血管升压药施用和补充氧气或高流量鼻插管。对于高危PE患者，应进行初级再灌注治疗，和共识指南基于证明获益的研究推荐将ST用于高危PE.再灌注的其他选择包括外科栓塞切除术和导管定向介入。
结论：急诊临床医生必须了解高危PE，包括临床评估，病理生理学,血流动力学不稳定和呼吸衰竭的管理，和初级再灌注疗法。
