Extracorporeal Membrane Oxygenation as Rescue Therapy for Patients with Suspected High-Risk Pulmonary Embolism: A Multicenter Retrospective Cohort Study

For patients with suspected high-risk pulmonary embolism (PE) who cannot undergo computed tomography pulmonary angiogram (CTPA) because of unstable hemodynamics, the optimal strategy, namely, prioritizing extracorporeal membrane oxygenation (ECMO) or revascularization, remains unclear.

This study investigated whether prioritizing ECMO is associated with increased survival rates.

A total of 117 patients with suspected high-risk PE admitted to the intensive care unit (ICU) at four ECMO centers were retrospectively enrolled (2013-2024).

Among these patients, 79 received ECMO (ECMO group), whereas 38 underwent thrombolysis therapy (thrombolysis group). The baseline and preintervention management characteristics were comparable between the groups. In-hospital mortality was lower in the ECMO group than in the thrombolysis group (33/79, 41.8% vs 22/38, 57.9%), although the difference was not significant (P=0.15). Multivariate Cox analysis revealed that treatment with ECMO was associated with a reduced risk of in-hospital mortality (hazard ratio [HR]=0.45, 95% confidence interval [CI] 0.25-0.79, P=0.006). An elevated pretreatment Acute Physiology and Chronic Health Evaluation II (APACHE II) score was identified as an independent risk factor for mortality (HR=1.14, 95% CI 1.06-1.22, P<0.001). Kaplan‒Meier curves and log-rank tests revealed better 28-day survival in the ECMO group than in the thrombolysis group (P=0.041). Among the 79 patients who received ECMO, 63 had CTPA-verified high-risk PE, with 34 surviving to discharge (34/63, 54.0%).

For hemodynamically unstable patients with suspected high-risk PE, prioritizing ECMO is a safe strategy that serves as an independent protective factor against in-hospital mortality, despite nonsignificant findings in unadjusted analyses. Larger studies are warranted to validate these results.