ESC/ERS PH 2022 — Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension

Pulmonary hypertension is hemodynamically defined as mean pulmonary arterial pressure (mPAP) >20 mmHg at rest. In acute RV failure/PH decompensation, support systemic perfusion, correct reversible triggers such as hypoxemia and severe acid-base derangement, optimize preload and ventilation, and use vasoactive/inotropic or pulmonary-vasodilator therapy according to the hemodynamic phenotype. Continuous parenteral prostacyclin therapy should not be abruptly interrupted because rebound pulmonary hypertension can occur. Mechanical circulatory support such as VA-ECMO is a specialist rescue/bridge option in selected refractory cases rather than a universal indication.