Efficacy of ECMO in Managing Suspected Fatal High-Risk Pulmonary Embolism and Prognostic Risk Factors in Confirmed Patients: An 11-Year Multicenter Retrospective Cohort Study

Purpose For patients with suspected fatal high-risk pulmonary embolism (PE) who cannot undergo computed tomography pulmonary angiography (CTPA), should ECMO rescue be prioritized over pulmonary vascular revascularization? What is the optimal revascularization strategy for patients under ECMO? What are the key risk factors affecting prognosis? This study addresses these questions to improve outcomes in high-risk PE. Methods Clinical data of 143 patients with suspected fatal high-risk PE admitted to five ECMO centers (January 2013-January 2024) were retrospectively analyzed. Results 1. Of 143 patients, 79 initially received ECMO (ECMO group), whereas 64 received revascularization (non-ECMO group). The baseline characteristics were similar between the two groups. However, the 28-Day mortality rate was lower in the ECMO group (49.4%, 39/79) than in the non-ECMO group (71.9%, 46/64; P < 0.05). 2. Among 79 ECMO-treated patients, CTPA confirmed PE in 63. Successful ECMO weaning rate was 58.7% (37/63), ECMO duration was 3.7 ± 3.3 days, and the survival to discharge was 54.0% (34/63). 3. Comparisons among ECMO + surgical thrombectomy, ECMO + thrombolysis, and ECMO alone groups showed the lowest 28-Day mortality with ECMO + surgical thrombectomy (9.1% vs 50.0% vs 52.5%, P < 0.05). 4. Logistic Regression Analysis identified the time from shock to ECMO as an independent risk factor affecting prognosis (P < 0.05). Conclusions For patients with suspected fatal high-risk PE, treating the primary disease under ECMO reduces mortality. Surgical thrombectomy may be considered for eligible patients. The time from shock to ECMO is an important factor affecting prognosis in confirmed cases.