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.