In massive pulmonary embolism (PE), endovascular therapies¹ and extracorporeal membrane oxygenation (ECMO)² are increasingly utilised. However, the impact of combining endovascular therapies with ECMO on shock resolution and clinical recovery remains unclear. We aimed to compare physiological and clinical outcomes between patients with massive PE who received ECMO with endovascular therapy or ECMO with standard anticoagulation alone.