F-45 | Readmissions in High-Risk Pulmonary Embolism Requiring Extracorporeal Membrane Oxygenation Support: A 5-Year National Experience

While extracorporeal membrane oxygenation (ECMO) support for high-risk pulmonary embolism (PE) has been elucidated, there is limited data on the long-term outcomes of this population. 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 rates, causes, and predictors of readmission in cohorts with and without ECMO support. Of the 1,952,640 patients, 5,604 (0.29%) received ECMO support. 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). In the survivors (ECMO group 3082 55% and non-ECMO group 1,849,684 95%), readmissions were lower in those requiring ECMO (2.9%) versus those not on ECMO (7%), p =0.00 (Figure 1). In the ECMO group, the most common causes of readmission were sepsis (35.47%), CKD with heart failure (20.03%), and COPD exacerbation (19.35%). The predictors of readmission were young age (18–40 years) (OR 1.05, 95% CI 1.03–1.08), discharge to short-term rehab (OR 1.31, 95% CI 1.23–1.37), AKI (OR 1.03, 95% CI 1.02-1.04), non-septic shock (OR 1.07, 95% CI 1.01–1.14), and surgical thrombectomy (OR 1.90, 95% CI 1.53-2.35). Patients with high-risk PE have high in-hospital mortality but a lower risk of readmissions. These data highlight the need for careful post-discharge care, including understanding out-of-hospital mortality that was not captured in this dataset.