Severe forms of pulmonary embolism (PE) in children, althought rare, cause significant morbidity and mortality. We review the pathophysiologic features of severe (high-risk and intermediate-risk) PE and suggest novel pediatric-specific risk stratifications and an acute treatment algorithm to expedite emergent decision-making. We defined pediatric high-risk PE as causing cardiopulmonary arrest, sustained hypotension, or normotension with signs or symptoms of shock. Rapid primary reperfusion should be pursued with either surgical embolectomy or systemic thrombolysis in conjunction with a heparin infusion and supportive care as appropriate. We defined pediatric intermediate-risk PE as a lack of systemic hypotension or compensated shock, but with evidence of right ventricular strain by imaging, myocardial necrosis by elevated cardiac troponin levels, or both. The decision to pursue primary reperfusion in this group is complex and should be reserved for patients with more severe disease; anticoagulation alone also may be appropriate in these patients. If primary reperfusion is pursued, catheter-based therapies may be beneficial. Acute management of severe PE in children may include systemic thrombolysis, surgical embolectomy, catheter-based therapies, or anticoagulation alone and may depend on patient and institutional factors. Pediatric emergency and intensive care physicians should be familiar with the risks and benefits of each therapy to expedite care. PE response teams also may have added benefit in streamlining care during these critical events.

儿童中严重形式的肺栓塞 (PE) 尽管很少见，但会导致显着的发病率和死亡率。我们回顾了严重（高风险和中风险）PE 的病理生理学特征，并提出了新的儿科特异性风险分层和急性治疗算法，以加快紧急决策制定。我们将儿科高危 PE 定义为导致心肺骤停、持续性低血压或血压正常并伴有休克体征或症状。应通过外科取栓术或全身溶栓结合肝素输注和适当的支持治疗来进行快速初次再灌注。我们将儿科中度风险 PE 定义为没有全身性低血压或代偿性休克，但有影像学证据表明右心室劳损，心肌肌钙蛋白水平升高导致心肌坏死，或两者。对该组进行初次再灌注的决定很复杂，应留给病情更严重的患者；单独抗凝治疗也可能适用于这些患者。如果进行初次再灌注，基于导管的治疗可能是有益的。儿童严重 PE 的急性处理可能包括全身溶栓、手术取栓、基于导管的治疗或单独抗凝治疗，并且可能取决于患者和机构因素。儿科急诊和重症监护医师应熟悉每种疗法的风险和益处，以加快护理速度。PE 响应团队还可能在这些关键事件期间简化护理方面带来额外好处。单独抗凝治疗也可能适用于这些患者。如果进行初次再灌注，基于导管的治疗可能是有益的。儿童严重 PE 的急性处理可能包括全身溶栓、手术取栓、基于导管的治疗或单独抗凝治疗，并且可能取决于患者和机构因素。儿科急诊和重症监护医师应熟悉每种疗法的风险和益处，以加快护理速度。PE 响应团队还可能在这些关键事件期间简化护理方面带来额外好处。单独抗凝治疗也可能适用于这些患者。如果进行初次再灌注，基于导管的治疗可能是有益的。儿童严重 PE 的急性处理可能包括全身溶栓、手术取栓、基于导管的治疗或单独抗凝治疗，并且可能取决于患者和机构因素。儿科急诊和重症监护医师应熟悉每种疗法的风险和益处，以加快护理速度。PE 响应团队还可能在这些关键事件期间简化护理方面带来额外好处。或单独抗凝，可能取决于患者和机构因素。儿科急诊和重症监护医师应熟悉每种疗法的风险和益处，以加快护理速度。PE 响应团队还可能在这些关键事件期间简化护理方面带来额外好处。或单独抗凝，可能取决于患者和机构因素。儿科急诊和重症监护医师应熟悉每种疗法的风险和益处，以加快护理速度。PE 响应团队还可能在这些关键事件期间简化护理方面带来额外好处。