Point-of-care ultrasound in hemodynamically unstable pulmonary embolism

Abstract

The recent guideline from the American Heart Association on acute pulmonary embolism provides an updated framework for diagnosis, risk stratification, and management. Computed tomography pulmonary angiography remains the reference standard for confirming pulmonary embolism. However, in critically ill patients with hemodynamic or respiratory instability, transport for definitive imaging may be unsafe or impractical. In this context, bedside evaluation becomes central to early decision-making. Point-of-care ultrasound (POCUS), particularly when performed as a multi-organ assessment integrating cardiac, pulmonary, and venous ultrasound, can rapidly identify signs of right ventricular dysfunction, detect thrombus in transit, and exclude alternative life-threatening causes of shock. Emerging evidence suggests that multi-organ POCUS has high diagnostic performance in critically ill patients with suspected pulmonary embolism. In unstable patients, bedside ultrasound may therefore provide clinically actionable information to support timely therapeutic decisions when definitive imaging is not immediately feasible.