Simultaneous thrombolysis and extracorporeal membrane oxygenation for acute massive pulmonary emboli

Abstract Background Extracorporeal membrane oxygenation (ECMO) has been used in patients with circulatory collapse or extremely unstable hemodynamics caused by acute massive pulmonary embolism (PE). The effectiveness of simultaneous thrombolytic therapy has been rarely investigated in these patients after being stabilized with ECMO. Methods From January 2008 to December 2018, consecutive patients with acute massive PE requiring ECMO supported in a tertiary medical center were included for retrospective analysis. Results Thirteen patients with PE underwent ECMO implantation and received subsequent thrombolytic therapy as a definite treatment for PE. All patients survived their ECMO courses to a successful de-cannulation, with a mean ECMO support duration of 6.23±4.69 days. Eleven (84.62%) of these patients survived to hospital discharge. All of these survivors were alive during the follow-up, although two (18.2%) of them had permanent dysfunctional neurological complications. Major bleeding complications occurred in four patients (30.77%), while none of them had intracranial hemorrhage. Systemic thrombolysis showed comparable outcomes of catheter-directed thrombolysis in our patients who underwent ECMO. Conclusions Thrombolysis-based therapeutic strategy under ECMO could be a relatively safe and effective definitive treatment for patients with acute massive PE, even for those who were resuscitated. Bleeding complications remain a major concern and should be monitored and managed immediately.