ID:51 FC-D11-3 ECMO For Massive Pulmonary Embolism (MPE): A Focused Systematic Review And Meta-Analysis Of In-Hospital Mortality

Background: Massive pulmonary embolism (MPE) is associated with high early mortality due to acute right ventricular failure, cardiogenic shock, and cardiac arrest. Extracorporeal membrane oxygenation (ECMO) has been increasingly used as a rescue strategy to stabilize hemodynamics and gas exchange while definitive reperfusion therapies are performed. However, evidence regarding outcomes remains limited and heterogeneous. Methods: We conducted a focused systematic review and meta-analysis of retrospective single-center studies reporting outcomes of adult patients with MPE treated with ECMO. Three eligible studies were included (Lin et al., 2021; Moon et al., 2018; George et al., 2022). The primary outcome was in-hospital mortality. Pooled mortality was estimated using a random-effects model, and heterogeneity was assessed using the I2 statistic. Results: A total of 37 patients with massive pulmonary embolism supported with ECMO were analyzed. The crude in-hospital mortality was 37.8% (14/37). Random-effects meta-analysis demonstrated a pooled in-hospital mortality of 36.3% (95% CI 10.0–62.6%), with substantial heterogeneity between studies (I2 = 69.8%). Individual study mortality ranged from 15.4% to 57.1%. Most patients experienced cardiac arrest, refractory shock, or severe hemodynamic collapse prior to ECMO initiation. ECMO was mainly used as a salvage or bridging therapy to reperfusion strategies, including thrombolysis and surgical or catheter-based embolectomy. Conclusion: In patients with MPE complicated by circulatory collapse, ECMO is associated with survival in approximately two-thirds of cases, despite significant heterogeneity. ECMO may provide life-saving stabilization in otherwise fatal MPE, but further prospective multicenter studies are needed.