Abstract 16338: Outcomes in Patients With High-Risk Pulmonary Embolism Undergoing Extracorporeal Membrane Oxygenation and Adjunctive Treatment Strategy, Including Percutaneous and Surgical Management- A Retrospective Study at a Tertiary Care Center

Introduction: The management of high-risk PE has remained challenging with high mortality rates. Several first-line treatments have been utilized, including percutaneous, surgical, and medical therapies. Extracorporeal membrane oxygenation (ECMO) has been utilized as a bridge toward definitive treatment in patients with persistent hemodynamic instability. Data on the use of combined ECMO and percutaneous management in high-risk PE are limited.

Hypothesis: The goal of this study is to examine outcomes in patients with high-risk PE undergoing ECMO by their adjunctive treatment strategy (catheter-directed thrombolysis, percutaneous mechanical thrombectomy, surgical thrombectomy, systemic thrombolysis, or anticoagulation alone).

Methods: Retrospective chart review at a tertiary care center of patients with high-risk PE undergoing ECMO between 2016-2023 was performed. Patients were classified into six groups by their adjunctive treatment strategy (see figure 1). Baseline clinical factors, predisposing factors for venous thromboembolism, cardiac arrest data, echocardiography, hospital course, and mortality were compared by ANOVA and chi-squared tests. Primary outcome of 30-day all-cause mortality was compared with Kaplan-Meier curve with log-rank test.

Results: A total of 55 patients were included. Of these patients, 36/55 (67.3%) had a cardiac arrest. The overall all-cause 30-day mortality was 25/55 (45%). Patients receiving multiple therapies were younger compared to other groups (p value = 0.003). All-cause mortality was lower amongst patients who received interventional procedures compared with those who received medical management only (see figure).

Conclusions: Our findings favor the use of combined ECMO and adjunctive procedural approaches rather than adjunctive medical therapies in patients with high-risk PE.