In-Hospital Outcomes and Readmissions in High-Risk Pulmonary Embolism Patients Requiring Extracorporeal Membrane Oxygenation Support

There are limited data on the use of extracorporeal membrane oxygenation (ECMO) in high-risk pulmonary embolism (PE) patients. We analyzed the use of ECMO in high-risk PE patients (defined as requiring vasopressors, with cardiogenic shock, or cardiac arrest) using the National Readmission Database (2016-2020) to assess the outcomes of in-hospital mortality, hospitalization costs and length of stay (LOS). Among 130,486 patients, 1,685 (1.3%) received ECMO. The ECMO cohort was on average younger (54 vs. 65 years), male, admitted to urban hospitals, and had higher rates of multiorgan failure. The cohort receiving ECMO support received definitive PE therapies, such as thrombolysis and thrombectomy, more frequently. In-hospital mortality was similar between the cohorts with and without ECMO (46% vs. 46%). The ECMO cohort had greater LOS (20 vs. 10 days) and costs ($622,026 vs. $142,390). Extracorporeal membrane oxygenation patients had higher 30 day readmission rates (6% vs. 1%; hazard ratio 8.42; p < 0.001), with sepsis, PE, and heart failure being common causes. In 1,065 propensity matched pairs, the in-hospital mortality was comparable between the two cohorts (odds ratio: 0.90 [95% confidence interval: 0.75-1.08]; p = 0.25). In conclusion, compared to those not receiving ECMO support, ECMO-supported high-risk PE patients had similar in-hospital mortality but more frequent readmissions.