Management of Severe Pulmonary Embolism in Intensive Care: A 10-Year Retrospective on Thrombolysis Utilization at a Referral Hospital in Sub-Saharan Africa

Background: Pulmonary embolism (PE), particularly in its severe form, presents a critical clinical challenge requiring immediate intervention. Thrombolytic therapy is widely recognized as a cornerstone of treatment, but its application in settings with limited resources, such as in Sub-Saharan Africa, is not well documented. This study investigates the role of thrombolysis in managing severe pulmonary embolism in an intensive care unit (ICU) at a leading referral hospital in Sub-Saharan Africa. Methods: We performed a retrospective analysis of patients admitted to the ICU with severe pulmonary embolism over a 10-year period (2013-2022) at a major tertiary hospital in Sub-Saharan Africa. Clinical data, including demographic characteristics, treatment modalities, and outcomes, were reviewed. The primary outcome was in-hospital mortality, with secondary outcomes focusing on complications and factors influencing survival. Results: Among 150 patients diagnosed with severe pulmonary embolism, 13 (8.7%) received thrombolytic therapy. The average age of the cohort was 48 years (SD = 12), and comorbidities such as hypertension (35%) and diabetes (20%) were prevalent. The mortality rate for patients who received thrombolysis was significantly lower at 15%, compared to 45% in those who did not receive thrombolysis (p < 0.05). Complications in the thrombolysis group included major hemorrhages (15%), with 3% of patients experiencing cerebral bleeding. Delays in thrombolytic administration, particularly beyond 3 hours, were linked to worse outcomes (p < 0.01). Conclusions: In this Sub-Saharan African ICU cohort, thrombolysis substantially decreased in-hospital mortality in patients with severe pulmonary embolism. While the therapy was administered to only a small proportion of patients due to resource limitations and delays, its use highlighted its efficacy. This study emphasizes the need for timely thrombolysis and the improvement of healthcare infrastructure in resource-constrained environments to enhance outcomes for patients with life-threatening pulmonary embolism.