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Akut lungemboli med hemodynamisk påverkan. Handläggning och behandling

Journal article
Authors Kristina Svennerholm
Leif Lapidus
Carl Johan Malm
Bengt Redfors
Lennart Stigendal
Karin Zachrisson Jönsson
Christian Rylander
Published in Läkartidningen
Volume 111
Issue 15
Pages 669-72
ISSN 0023-7205
Publication year 2014
Published at
Pages 669-72
Language sv
Keywords Acute Disease, Adult, Algorithms, Female, Hemodynamics, Humans, Male, Middle Aged, Pulmonary Embolism, drug therapy, physiopathology, surgery, therapy, Treatment Outcome
Subject categories Anesthesiology and Intensive Care

Abstract

Pulmonary embolism in adults has increased from 54 to 86/100.000 in Sweden between 2001 and 2011, which is in line with European numbers and often attributed to the increased diagnostic use of computed tomography. Acute pulmonary embolism with circulatory fail­ure, manifested as systolic blood pressure below 90 mm Hg, carries mortality up to 50 % but its true incidence in Sweden is not known. The primary treatment in this situation is intravenous thrombolysis. If this is contraindicated or does not improve the condition, there are several non-pharmacological options. National guidelines to support a choice between them do not exist and regional recommendations vary in their prioritisation between catheter intervention and surgical embolectomy. In view of recent development of these techniques and the added possibility of applying extracorporeal membrane oxygenation to the patient in circulatory failure, this article summarises the treatment options and their rationale. Pathophysiology supporting the different treatment modalities is briefly described and an algorithm is proposed, emphasising communication and interdisciplinary review of the individual case. Efficient handling of patients in circulatory failure with imminent risk of cardiac arrest may help saving additional lives in this group that suffers from a high mortality.

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