• Eugene Yuriditsky, Jan Bakker, Carlos L Alviar, Sripal Bangalore, and James M Horowitz.
• Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States of America. Electronic address: Eugene.yuriditsky@nyulangone.org.
• J Crit Care. 2024 Dec 1; 84: 154891154891.

AbstractEmergent reperfusion, most commonly with the administration of thrombolytic agents, is the recommended management approach for patients presenting with high-risk, or hemodynamically unstable pulmonary embolism. However, a subset of patients with a more catastrophic presentation, including refractory shock and impending or active cardiopulmonary arrest, may require immediate circulatory support. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be deployed rapidly by the well-trained team and provide systemic perfusion allowing for hemodynamic stabilization. Subsequent embolectomy or a standalone strategy allowing for thrombus autolysis may be followed with decannulation after several days. Retrospective studies and registry data suggest favorable clinical outcomes with the use of VA-ECMO as an upfront stabilization strategy even among patients presenting with cardiopulmonary arrest. In this review, we discuss the physiologic rationale, evidence base, and an approach to ECMO deployment and subsequent management strategies among select patients with high-risk pulmonary embolism.Copyright © 2024. Published by Elsevier Inc.

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