11th C: death due to “sudden breathless sleep” found to be due to thrombus in pulmonary vessels
1846: classic triad of venostasis, hypercoagulability & vessel wall inflammation causing DVT was worked out by von Virchow who also was the 1st to show that pulm. arterial thrombus 1st develops in deep veins of extremities. He coined the term embolism to describe this phenomenon. He also demonstrated anatomic anastomoses of bronchial arteries with which he explained the reason for failure of infarction to occur in all cases of PE.
1873: Bergmann recognised fat embolism in trauma pts
1891: 1st report of inhaled oxygen saving a person's life from PE
early 1900's: Trendelenberg conceived & popularised procedures for pulm. thromboembolectomy & for vena caval interuption, but operative mortality (almost 100%) same as disease mortality
1924: Kirschner performed 1st pulmonary embolectomy with survival (not done in USA until 1958!)
1930's: heparin introduced & radically changed Mx of PEs from surgical (despite its ~100% mortality) to medical
1930's: streptokinase discovered
1951: urokinase discovered
mid-1960's: perfusion lung scans developed
late 1960's & early 1970's: 2 large clinical trials demonstrated benefits of thrombolysis if haemodynamically unstable
pre-1970: it was thought that a pO2 > 80mmHg excluded PE & such pts were excluded from PE trials!
1970's: V/Q lung scans developed, dramatically changing diagnostic approach to PE
1977: USA FDA recommends SK protocol: 250,000U load/30min then 100,000U/hr for 24hrs
1978: USA FDA recommends urokinase protocol: 4,400IU/kg load/10min then, 4,400IU/kg/hr for 12-24hr
1990: PIOPED study published
1990: thrombolytics shown to decrease long term (7yr) pulmonary artery pressures in 23 randomised pts with PEs
1990: USA FDA recommends r-tPA protocol: 100mg over 2hrs
1992: thrombolytics shown to reduce 1 yr mortality from PEs from 19% with heparin alone to 8.7% in 399 pts
1997: helical multi-slice CT scanners becoming widespread allowing use in Dx of PE