Abstract Introduction Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly employed as a salvage therapy for patients with high-risk pulmonary embolism (PE) complicated by cardiogenic shock or circulatory collapse. While its use has expanded across tertiary and community centers, real-world data characterizing early outcomes and complications remain limited. Methods We performed a multicenter retrospective analysis using the TriNetX U.S. Collaborative Network, which aggregates de-identified electronic health records from 70 healthcare organizations nationwide. Adults (≥18 years) with a diagnosis of high-risk PE who experienced hemodynamic compromise and underwent V-A ECMO between 2005 and 2025 were included. Outcomes within 30 days following ECMO initiation were assessed, including all-cause mortality (primary endpoint), acute kidney injury (AKI), cerebrovascular accident (CVA), and tracheostomy requirement. Kaplan-Meier survival estimates and risk analyses were used to evaluate short-term event probabilities. Results A total of 1,605 patients met inclusion criteria. The mean age was 54.2 ± 16.2 years, 55% were male, and 62.2% were White while 24.4% were Black. The 30-day all-cause mortality rate was 30.2%, corresponding to a Kaplan-Meier survival probability of 68.5%. AKI occurred in 41.1% of patients, CVA in 14.5%, and tracheostomy was required in 6.9%. Survival probability at 30 days differed by complication, at 91.7% for patients requiring tracheostomy, 84.1% for those with CVA, and 56.2% among those who developed AKI. Conclusions In this large, multicenter real-world cohort of patients with high-risk PE supported by V-A ECMO, nearly one-third of patients died within 30 days of initiation. Acute kidney injury and neurologic complications were frequent, reflecting the high physiologic burden and complexity of care in this critically ill population. These findings emphasize the significant early morbidity and mortality associated with ECMO in massive PE and underscore the need for prospective, granular studies to refine patient selection, optimize peri-ECMO management, and improve post-support outcomes. This abstract is funded by: None
Garapati et al. (Fri,) studied this question.
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