Background Patients with massive/sub-massive pulmonary embolism (PE) and right ventricular strain have a significant risk of hemodynamic collapse. VA ECMO support provides an excellent salvage option for patients with acute/unstable pulmonary embolism with obstructive cardiogenic shock undergoing mechanical thrombectomy. Using VA-ECMO for a “protective PE” procedure allows control of hemodynamics and enables interventionalists to perform the thrombectomy in a more controlled environment. Here, we present our experience. Methods A retrospective data analysis on consecutive VA ECMO patients with cardiogenic shock secondary to pulmonary embolism was abstracted from August 2022 to June 2024. Results Patient characteristics and outcomes are described in Table 1. A total of 19 patients met inclusion criteria. The mean age is 46.3, and the majority of the population was male, 57.9%. Predisposing factors for PE were evenly distributed. Cardiac arrest was present in 57.9% of patients; mean lactate was 8.1, and 68.4% of patients required at least two vasopressors. The mean Survival After Veno-Arterial ECMO (SAVE) score was -4.7. Fifteen out of nineteen patients (79%) survived hospital discharge. Despite correction of metabolic derangements, four patients (21%) expired on ECMO due to anoxic injury related to prolonged CPR. Conclusion The concomitant use of VA ECMO and mechanical pulmonary thrombectomy demonstrated to be an effective treatment modality for massive PE with cardiogenic shock. This combination of therapies allows interventionalists to perform protective thrombectomies in highly acute patients with better hemodynamic control while on ECMO.

Analytical, Diagnostic and Therapeutic Techniques and Equipment
Cardiovascular Diseases
Diseases
Internal Medicine
Medical Specialties
Medicine and Health Sciences
Respiratory Tract Diseases
Therapeutics