F-44 | In-Hospital Outcomes of Extra-Corporeal Membrane Oxygenation Use in High-Risk Pulmonary Embolism: A National Readmission Database Analysis (2016-2020)

High-risk pulmonary embolism (PE) is associated with obstructive/cardiogenic shock and cardiac arrest. In recent years, there is growing interest in extracorporeal membrane oxygenation (ECMO) support in high-risk PE. Using the National Readmission Database (2016–2020), we identified high-risk PE patients (requiring vasopressors, cardiogenic shock, or cardiac arrest). The cohorts were divided into those who did and did not receive ECMO support. Outcomes of interest included in-hospital mortality, predictors of in-hospital mortality, length of hospital stay (LOS), and hospitalization charges. We also sought to identify predictors of in-hospital mortality in the ECMO cohort. Of the 1, 952, 640 patients during this 5-year period, 5, 604 patients (0. 29%) received ECMO support. Compared to those without ECMO, those receiving ECMO were on average younger (mean age 64. 5±18. 5 vs. 66±17) and male (60. 8% vs. 48%). Systemic thrombolytics (1. 7% vs 0. 45%), catheter-directed thrombolytics (1. 7% vs 0. 46%), aspiration thrombectomy (2. 4% vs. 0. 13%), and surgical thrombectomy (2. 4% vs. 0. 13%) were used in those with and without ECMO therapy. In-hospital mortality was higher in those requiring ECMO compared to those who didn't require it (45% vs. 5%; unadjusted OR 1. 82 95% CI 1. 39-2. 25; adjusted OR 2. 3 95% CI 1. 65-2. 95; p = 0. 000). The mean LOS (22±2. 7 vs. 5±1 days, p=0. 000) and hospitalization costs (699, 112 ± 62509 vs. 53380± 445) were higher in the ECMO cohort compared to those without. AKI (69. 4% vs 22%) and need for dialysis (1. 6% vs 1. 4%) occurred more in the ECMO group compared to other. In a multivariable analysis, LOS >7 days (O1. 19, 95% CI 1. 15–1. 22), history of stroke (OR 1. 15, 95% CI 1. 12-1. 19), electrolyte derangement (OR 2. 05, 95% CI 2. 02-2. 09), severity of illness indicated by Charlson Comorbidity Index (OR 1. 38, 95% CI 1. 32-1. 40), and AKI (OR 2. 41, 95% CI 2. 37–2. 45) predicted inpatient mortality. In this 5-year national study, high-risk PE patients requiring ECMO constitute a sick cohort with nearly 50% in-hospital mortality, significantly lower than high-risk PE not requiring ECMO. Further granular risk-stratification schemes are needed to better classify the high-risk PE category.