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Pulmonary embolism

Circulation & Shock

For healthcare professionals. This information does not replace clinical judgement in the individual case; the current summary of product characteristics and the guidelines cited are authoritative.

Medically reviewed: Dr. med. univ. Daniel Pehböck, DESA, 03.11.2026

Pulmonary embolism: Recognition, Clinical probability (stable patients), Risk stratification (ESC 2019), Prehospital treatment, Anticoagulation, Systemic thrombolysis – concise for emergency, anaesthesia and intensive care teams, with sources and medically reviewed.

What the chapter covers

  1. Recognition
  2. Clinical probability (stable patients)
  3. Risk stratification (ESC 2019)
  4. Prehospital treatment
  5. Anticoagulation
  6. Systemic thrombolysis
  7. Cardiac arrest in pulmonary embolism (ERC 2025)
  8. Catheter, surgery, ECMO – in brief
  9. Pregnancy – in brief
  10. Guideline status and differences

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Sources and guidelines

  1. Konstantinides SV, Meyer G, Becattini C et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020;41:543–603.
  2. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. Online zuerst J Am Coll Cardiol 19.02.2026 (JACC 2026;87(13), doi 10.1016/j.jacc.2025.11.005); Circulation 2026;153(12):e977–e1051 (24.03.2026)
  3. Deutsche Gesellschaft für Angiologie.
  4. Lott C et al. European Resuscitation Council Guidelines 2025: Special Circumstances in Resuscitation. Resuscitation 2025;215 Suppl 1:110753.
  5. Soar J, Böttiger BW et al. European Resuscitation Council Guidelines 2025 Adult Advanced Life Support. Resuscitation 2025;215 Suppl 1:110769 (Korrigendum 2026).
  6. Stevens SM, Woller SC, Baumann Kreuziger L et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest 2021;160:e545–e608.
  7. Ortel TL, Neumann I, Ageno W et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism.
  8. De Backer J, Haugaa KH et al. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy. Eur Heart J 2025, Kapitel 11.4 Akute venöse Thromboembolie (therapeutisches NMH sofort bei Verdacht, mind. 6 Wochen postpartal; kathetergestützte Therapie bei schwerer LE erwägbar; geplante Entbindung)
  9. Wells PS, Anderson DR, Rodger M et al. Derivation of a simple clinical model to categorize patients' probability of pulmonary embolism.
  10. Klok FA, Mos IC, Nijkeuter M et al. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med 2008;168:2131–2136.
  11. Kline JA, Mitchell AM, Kabrhel C et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004;2:1247–1255; Freund Y, Cachanado M, Aubry A et al. Effect of the Pulmonary Embolism Rule-Out Criteria on subsequent thromboembolic events among low-risk emergency department patients.
  12. Jiménez D, Aujesky D, Moores L et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170:1383–1389.
  13. Righini M, Van Es J, Den Exter PL et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism.
  14. van der Hulle T, Cheung WY, Kooij S et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study)
  15. Meyer G, Vicaut E, Danays T et al. (PEITHO). Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014;370:1402–1411 (Tenecteplase gewichtsadaptiert als Einzelbolus vs. Placebo.
  16. PRAGUE-26.
  17. High-risk Investigator Group. Prehospital thrombolytic treatment of high-risk acute pulmonary embolism. Crit Care 2025 (online 07.07.2025): 69 Patient:innen mit präklinischer systemischer Lyse, Folgestrategien u. a. VA-ECMO, erneute Lyse, kathetergestützte Therapie.
  18. McDonagh TA et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599–3726; 2023 Focused Update, Eur Heart J 2023;44:3627–3639.
  19. Don't Forget the Bubbles. What's new.
  20. Summaries of product characteristics of authorised products – product and section for each dose in the app.