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

Background and aims: 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.

Methods: 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.

Results: 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.

Conclusion: 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.