Intensive Care Treatment in Acute Pulmonary Embolism

Karsten Keller (Mainz)1, I. Sagoschen (Mainz)1, I. T. Farmakis (Mainz)2, K. Mohr (Mainz)2, L. Valerio (Mainz)2, J. Wild (Marburg)3, S. Barco (Zürich)4, F. P. Schmidt (Trier)5, T. Gori (Mainz)6, C. Espinola-Klein (Mainz)7, T. Münzel (Mainz)8, P. Lurz (Mainz)8, S. Konstantinides (Mainz)9, L. Hobohm (Mainz)6

1Universitätsmedizin Mainz Zentrum für Kardiologie Mainz, Deutschland; 2Universitätsmedizin Mainz Centrum für Thrombose und Hämostase Mainz, Deutschland; 3Universitätsklinikum Giessen und Marburg GmbH Klinik für Innere Medizin - Schwerpunkt Kardiologie Marburg, Deutschland; 4UniversitätsSpital Zürich Abteilung für Angiologie Zürich, Schweiz; 5Klinikum Mutterhaus der Borromäerinnen Abteilung für Kardiologie Trier, Deutschland; 6Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie Mainz, Deutschland; 7Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie, Kardiologie III-Angiologie Mainz, Deutschland; 8Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; 9Universitätsmedizin der Johannes Gutenberg-Universität Mainz Centrum für Thrombose und Hämostase Mainz, Deutschland



Pulmonary embolism (PE) is a potentially life-threatening condition representing the third most common cardiovascular cause of death after myocardial infarction and stroke. Since acute right ventricular failure with the result of low systemic output is the leading cause of death in patients with high-risk PE (haemodynamic instability) and also in selected patients with threatening hemodynamic compromise (intermediate high-risk), immediate reperfusion is recommended. In addition, intensive care unit (ICU) treatment is another important component regarding adequate management of these hemodynamically compromised PE patients. We aimed to identify differences in patient-profile regarding risk factors and comorbidities between PE patients, who had to be admitted to an ICU and these who are treated on normal ward without ICU.


We used the German nationwide inpatient sample to analyse all hospitalizations of patients with PE in Germany 2016-2020 stratified for ICU admission (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2016-2020, own calculations).


Overall, 484,859 hospitalized patients with PE (median age 71.0 [IQR 59.0 to 80.0] years; female sex 51.0%) were treated in German hospitals during the years 2016-2020. Among these, 92,313 (19.0%) were admitted to ICU.

Patients treated on ICU were in median 3 years younger (69.0 [58.0-78.0] vs. 72.0 [60.0-80.0] years, P<0.001), more often male (52.9% vs. 48.1%, P<0.001), had higher prevalence of cardiovascular risk factors as well as comorbidities such as coronary artery disease (16.4% vs. 12.5%, P<0.001), heart failure (34.7% vs. 20.6%, P<0.001), atrial fibrillation/flutter (22.3% vs. 12.3%, P<0.001) and kidney failure (36.6% vs. 21.1%, P<0.001).

All clinical signs of PE severity, comprising shock (17.4% vs. 2.4%, P<0.001) and right ventricular dysfunction (38.5% vs. 20.4%, P<0.001) were more common identified in patients with ICU treatment.

Reperfusion treatments of systemic thrombolysis (10.3% vs. 2.7%, P<0.001), catheter-directed treatments (1.1% vs. 0.2%, P<0.001) and surgical embolectomy (0.60% vs. 0.02%, P<0.001) were more often used in PE patients with ICU treatment.

Length of in-hospital stay was substantially longer in PE patients with necessity of ICU treatment (15.0 [8.0-27.0] vs. 7.0 [4.0-12.0], P<0.001).

In-hospital case-fatality rate was higher in PE patients, who had to be treated on ICU vs. those without ICU treatment (22.7% vs. 10.7%, P<0.001).

ICU admission was independently associated with prolonged length of in-hospital stay >10 days (OR 4.22 [95%CI 4.15-4.29], P<0.001) and increased in-hospital case-fatality (OR 2.35 [95%CI 2.30-2.40], P<0.001).

Conclusions: PE patients who had to be treated in ICU had an aggravated comorbidity-profile and revealed more often signs of hemodynamic compromise. Consecutively, they were more often treated with reperfusion and were afflicted by higher risk to die.

Diese Seite teilen