(1693) VA ECMO for Massive/High-Risk Pulmonary Embolism: Outcomes From an Intensivist-Led ECMO Program

Introduction: Pulmonary embolism (PE) is the third leading cause of cardiovascular death. Patients with PE and hemodynamic instability or cardiac arrest have the highest mortality rates. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be used to restore or maintain circulation in patients with massive/high-risk PE; however, the reported outcomes vary.

Methods: A retrospective chart review of all patients with massive/high-risk PE who required VA ECMO between 03/2016 and 04/2024. Baseline demographics and ECMO-specific data were collected. Additional variables included complications, hospital length-of-stay (LOS), and survival. Continuous variables are presented as median with 25%-75% interquartile range (IQR), and categorical variables are presented as numbers (percentage).

Results: A total of 34 patients (16 males and 18 females) with a median age of 56 (38.3-67) years had massive/high-risk PE and were supported with ECMO. All patients were supported with the VA mode, of which 33 (97.1%) were peripherally cannulated and one (2.9%) was centrally cannulated. Twenty-seven (79.4%) patients were cannulated at the "hub" center, all by one of our intensivists. Seven (20.6%) patients were cannulated at a referring hospital, with five cannulated by one of our intensivists and two by a surgeon, followed by transport to the "hub" center. The median duration of ECMO support was 6 (3.3-8) days, and median hospital LOS was 16 (8.3-29) days. Overall, 25 (73.6%) of patients survived to ECMO weaning and 22 (64.7%) survived to hospital discharge. Complications included major bleeding in two (5.8%) patients and neurological events in 10 (29.4%) patients; there were no infectious, ischemic, or hemolytic complications.

Conclusions: In this study of patients with massive/high-risk PE supported by VA ECMO, we demonstrate that good clinical outcomes are possible in an intensivist-led ECMO program. Future research is needed to determine the most appropriate role for VA ECMO in cases of massive/high-risk PE in various delivery models, including an intensivist-led model.