Early mechanical reperfusion in high-risk pulmonary embolism supported by venoarterial extracorporeal membrane oxygenation: a multicenter international cohort study

doi:10.1093/ajrccm/aamaf116

Organ support & nutrition

Early mechanical reperfusion in high-risk pulmonary embolism supported by venoarterial extracorporeal membrane oxygenation: a multicenter international cohort study

Am J Respir Crit Care MedPublished 23 Jan 2026Retrospective cohort study

Main finding · 90-day mortalityResultHazard ratio 0.68 95% CI 0.45–1.03

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Authors' conclusion

In this large international cohort of patients with high-risk PE on VA-ECMO, early mechanical reperfusion therapy was not associated with a reduction in 90-day mortality or ECMO duration.

Study context

Population: Adults treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for high-risk pulmonary embolism (PE) at 39 ECMO centres (2014–2024); patients dying within 12 hours or receiving delayed reperfusion excluded137 per matched group
Participants: 492 adults

Exposure: Early mechanical reperfusion on ECMO vs ECMO stand-alone
Early mechanical reperfusionn = 137
ECMO stand-alonen = 137reference
Outcome: Mortality (propensity-matched groups)
Follow-up: 90 days

Methodological detailsmulticentre, international, propensity-score matched

Multicentre
International
Propensity-score matched

Main finding

90-day mortality

Hazard ratio

0.68

95% CI 0.45–1.03

P = 0.07

By group

Early mechanical reperfusion32%

ECMO stand-alone39%

Early mechanical reperfusion vs ECMO stand-alone

HR 0.68 (95% CI 0.45–1.03); P = 0.07

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with early mechanical reperfusion ←→ Higher risk with early mechanical reperfusion →	Subdistribution HR (95% CI)	P value
ECMO weaning (subgroup without prior thrombolysis)	0.512	1.56 (1.03–2.36)	P = 0.04
	0.512Subdistribution hazard ratio (log scale)

ECMO duration and weaning rates, overall

Similar between groups

Safety

Bleeding in 50% of patients
No significant difference between groups

Original publication

Early mechanical reperfusion in high-risk pulmonary embolism supported by venoarterial extracorporeal membrane oxygenation: a multicenter international cohort study. Am J Respir Crit Care Med. Published 23 January 2026. doi:10.1093/ajrccm/aamaf116

Read the original article ↗

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