Composite Pulmonary Embolism Shock (CPES) Score
Stratifies risk of normotensive shock in patients with pulmonary embolism (PE).
Before use, ensure a diagnosis of intermediate-risk PE is made and that there is clinical concern for right ventricular strain or potential decompensation.
Advice
- This tool should not be the sole determinant of care; use in conjunction with thorough clinical evaluation and judgment.
- Consider using the score alongside independent assessment of imaging and biomarkers to assess right ventricular strain and overall risk.
- This score does not diagnose shock directly, but estimates the probability of reduced cardiac index despite preserved blood pressure.
- Patients with higher scores may benefit from early involvement of a pulmonary embolism response team (PERT) and consideration of advanced therapies.
Management
- For lower scores (<3), patients may be managed with standard anticoagulation and routine monitoring.
- With higher scores (≥3), consider:
- Closer observation (e.g., step-down or ICU settings).
- Further evaluation of RV function.
- Early involvement of an interventional team.
- In select high-risk patients, consider escalation to advanced therapies such as catheter-directed intervention or mechanical thrombectomy, particularly if there is evidence of worsening RV dysfunction or hypoperfusion.
Critical Actions
Monitor closely for signs of clinical decompensation, including worsening tachycardia, hypoxia, rising lactate, or end-organ hypoperfusion.