1 Context

Setting

ED / New diagnosis Inpatient / Already admitted

Stability window used by this tool: last 4–6 hours (ED).

Pulmonary/PERT already discussed?

Yes No Not available

2 Hemodynamics / Instability Screen

Cardiac arrest / CPR?

Yes No

SBP now (mmHg)

Lowest SBP in last 15 minutes (mmHg) optional

Baseline/arrival SBP (mmHg) optional

Sustained hypotension ≥15 minutes?

Yes No

Vasopressors

Evidence of hypoperfusion select all that apply

Lactate elevated and/or rising Altered mental status Oliguria/anuria Cool/clammy / poor perfusion

Lactate value (mmol/L) optional

Rising trend?

⚡ Hemodynamic Instability Detected

Remaining sections are not needed — this patient routes directly to the high-risk (massive) emergency reperfusion pathway.

5 Trajectory / Objective Deterioration

Objective deterioration within the stability window (ED: 4–6h).

Respiratory

Escalation in oxygen device class (e.g., RA→NC→NRB/HFNC→NIV→Intubation) Increasing O₂ requirement within window (even within same device class) SpO₂ < 90% despite escalation

Hemodynamics / Perfusion trend

SBP trending down OR clinically concerning trend Baseline SBP known and drop ≥20 mmHg within window New/worsening tachycardia (HR ≥110 persistent) Rising lactate trend or new elevation

Disposition

Escalation to higher level of care for physiologic need (floor→stepdown/ICU)

Do not use this if escalation occurred due to bed availability.

6 Timing / Anatomy / Safety Modifiers

Symptom onset (days) optional

Acute ≤14 days

Clot location

Contraindication to systemic thrombolysis?

Yes No Unknown

Current respiratory support

STORM-PE (RCT, 2024): In intermediate-high risk PE, computer-assisted vacuum thrombectomy + anticoagulation improved 48-hour RV/LV reduction vs anticoagulation alone and normalized vital signs earlier; no demonstrated mortality benefit; procedure risks exist.
PEERLESS (RCT, 2024): In patients selected for catheter intervention, large-bore mechanical thrombectomy outperformed catheter-directed thrombolysis on a composite driven by less deterioration/bailout and less ICU utilization/shorter LOS; no difference in mortality or major bleeding.
Guideline framing (ESC/ACC summaries): Systemic thrombolysis is reserved for high-risk hemodynamic instability; routine reperfusion is not recommended for stable intermediate-risk PE; catheter-based or surgical options are generally considered for rescue when instability develops or when thrombolysis is contraindicated/failed.

Access-site bleeding/hematoma; vascular injury
Pulmonary artery injury/rupture (rare, serious)
Cardiac irritation/arrhythmias; heart block (device-dependent)
Hemolysis and possible renal stress (device-dependent)
Limited reach for distal clot; residual segmental disease may persist
Potential embolization/clot migration

PE Reperfusion / IR Consult Triage

1 Context

2 Hemodynamics / Instability Screen

⚡ Hemodynamic Instability Detected

3 RV Dysfunction

4 Biomarkers

5 Trajectory / Objective Deterioration

6 Timing / Anatomy / Safety Modifiers

Evidence (selected)

Procedure considerations / complications

Recommendation

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