Non-mechanical haemodynamic support in acute pulmonary thromboembolism: a scoping review

Acute pulmonary thromboembolism (PE) may require haemodynamic supportive therapies while appropriate therapies for clot burden reduction are pursued. This scoping review aims to identify the non-mechanical haemodynamic support interventions that have been investigated for the management of acute PE, and to map the available evidence for each intervention.

An iterative search of MEDLINE, Embase, CINAHL and the Cochrane Library was performed to map all available animal studies, case-series, observational studies, human trials, systematic reviews and meta-analyses that investigate any non-mechanical haemodynamic support in acute PE.

6,362 unique articles were screened and of the 132 studies that met the eligibility criteria, 98 were animal studies, 31 human studies, and 3 were systematic reviews. Among all studies 57 different agents were found, including 16 among the human studies. 6 agents were investigated across 7 human randomised controlled trials (RCTs) and included inhaled nitric oxide, fluid, furosemide, diclofenac, sildenafil, and epoprostenol, but were limited to intermediate-risk PE and none demonstrated a mortality benefit from the intervention tested.

The evidence to guide clinical practice in the non-mechanical haemodynamic support of PE is severely limited. However, there are numerous candidate agents that could be further investigated. The high-risk group are an understudied population.