VA-ECOM assisted percutaneous mechanical thrombectomy treatment high-risk pulmonary embolism

Background: Percutaneous mechanical thrombectomy (PMT) is increasingly used in the treatment of intermediate and high-risk acute pulmonary embolism (PE), and the treatment of high-risk PE with the aid of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has also been reported. However, there are few reports of VA-ECOM-assisted PMT in the treatment of high-risk PE. The purpose of this study is to summarize the data of 11 patients with high-risk PE treated with VA-ECMO assisted PMT, and propose feasible treatment methods for such patients.

Methods: This multicenter retrospective study included patients with acute high-risk PE who were treated with VA-ECMO-assisted PMT from January 2021 to June 2024. The analysis focused on the right/left ventricle ratio, biomarkers, and pulmonary artery pressure before and after the VA-ECMO-assisted PMT treatment.

Results: All 11 high-risk PE patients suffered cardiac arrest before treatment, computered tomograhy pulmonary angiography (CTPA) confirmed the diagnosis of PE, and all patients received VA-ECMO-assisted PMT therapy. The median age of the 11 patients was 54 years (range 18-72), the median duration of ECMO was 4.48 days (range 1.04-18.02), and the mean hospitalization time was 21 days (range 14-112). All patients received percutaneous thrombectomy, achieving a 100% technical success rate. The mortality rate was 27.3% during the 90-day follow-up. The 12-month mortality rate was 36.4%.

Conclusion: VA-ECMO-assisted PMT technology can rapidly improve pulmonary hemodynamics while maintaining stable blood flow, thereby reducing in-hospital mortality in high-risk patients with pulmonary embolism complicated by cardiac arrest.