Outcomes of Venous-Arterial Extracorporeal Membrane Oxygenation Therapy in Acute Pulmonary Embolism: A Single-Center Experience

Outcomes of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy in acute pulmonary embolism. High-risk pulmonary embolism (PE) has a high mortality risk. VA-ECMO provides essential cardiopulmonary support, although data outcomes remain limited. We sought to describe the characteristics and clinical outcomes of patients supported with VA-ECMO for the management of high-risk PE. We retrospectively analyzed outcomes of adult patients treated with VA-ECMO for high-risk PE at the University of Minnesota between January 2015 and May 2024. High-risk PE was defined by the European Society of Cardiology criteria. Clinical, demographic, procedural, and outcome data were analyzed. Mortality predictors were assessed using logistic regression. Of 1350 patients supported by VA-ECMO, 58 (4.3%) presented with high-risk PE (69% cardiac arrest, 31% shock). Mortality was significantly higher among patients cannulated for cardiac arrest than for shock (72.5% vs. 33.3%, P = 0.005). An independent predictor of mortality was out-of-hospital cardiac arrest (OR 6.67, 95% CI 1.15-38.7, P = 0.035). The duration of CPR was shorter among survivors (25.9 vs. 44.2 min, P = 0.02). Neither catheter-directed therapy nor systemic thrombolysis was associated with survival. Major bleeding occurred in 67% of patients and was not significantly associated with mortality. Neurologic injury was the leading cause of death in cardiac arrest patients; multiorgan failure predominated in the shock group. Despite the use of VA-ECMO, mortality in high-risk PE remains elevated, but differed by indication for cannulation. Survival was higher in patients presenting with shock, in-hospital cardiac arrest, shorter CPR duration, and sustained return of spontaneous circulation. Further research is needed to define the role of VA-ECMO and adjunctive therapies across varied clinical presentations.