• Maxwell A Hockstein, Christina Creel-Bulos, Joshua Appelstein, Craig S Jabaley, and Michael J Stentz.
• Division of Critical Care, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA; Department of Critical Care, MedStar Washington Hospital Center, Washington, DC. Electronic address: max.hockstein@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2021 Sep 1; 35 (9): 2681-2685.

ObjectiveDespite advances in treatment, massive pulmonary embolism (PE) remains associated with significant morbidity and mortality. The role of venoarterial extracorporeal membrane oxygenation (VA ECMO) in the setting of massive PE is evolving and includes potential roles both in initial management and as a rescue strategy.DesignSingle-center case series that reported demographics and outcomes for patients with massive PE who underwent VA ECMO.SettingThis investigation was performed at a quaternary referral center with several hospitals throughout the greater Atlanta, GA, area.ParticipantsThe study comprised adult patients (age ≥18 y) admitted to the authors' hospital system. Patients were identified using an internal registry of ECMO patients that contains basic demographic information (age, weight, treatment dates and times, ECMO configuration) and primary diagnosis.InterventionsNo interventions were performed.Measurements And Main ResultsSeventeen patients who met the inclusion criteria were identified, with 16 patients cannulated peripherally and one patient cannulated centrally for VA ECMO. Survival to hospital discharge was 80% for patients who underwent VA ECMO as an initial approach versus 42% for those in whom it was used as a rescue modality.ConclusionsThe results suggested that patients placed on VA ECMO earlier during their course of massive PE may have improved mortality. Additional investigation is needed to clarify the optimal sequence and timing of therapies surrounding the initiation of VA ECMO in patients with massive PE.Copyright © 2021 Elsevier Inc. All rights reserved.

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