Extracorporeal Membrane Oxygenation Combined With Mechanical Thrombectomy Versus Extracorporeal Membrane Oxygenation Alone for High-Risk Pulmonary Embolism: A Systematic Review and Meta-analysis
In brief
Adding clot removal to ECMO has no proven survival benefit in severe pulmonary embolism
Across four observational studies involving 2,824 adults with high-risk pulmonary embolism, adding catheter-based clot removal to ECMO did not establish a mortality benefit; pooled estimates were highly imprecise, and larger studies also found no statistically significant survival difference. Hospital and intensive care stays were shorter, with no detected difference in major bleeding, but very low-certainty evidence leaves the treatment's benefits uncertain.
- Journal
- Journal of cardiothoracic and vascular anesthesia (Q2)
- Published
- 31 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Bashar Hasan, Sameh Taki Aldin, Kevin G Buda, Yahya A Alwatari, Mohammed M Firwana, Patrick M Wieruszewski, et al.
- PMID
- 42786027
- DOI
- 10.1053/j.jvca.2026.08.165
Why clinicians should know about it
- Picked for Epidemiology (top studies of the week, 27 September 2026).
Abstract
OBJECTIVES: To compare clinical outcomes of venoarterial (VA) extracorporeal membrane oxygenation (ECMO) combined with mechanical thrombectomy (MT) versus VA-ECMO alone in high-risk pulmonary embolism (PE). DESIGN: Systematic review and meta-analysis. SETTING: PubMed and Embase search from inception through October 2025. PARTICIPANTS: Adults with high-risk PE requiring VA-ECMO support. INTERVENTIONS: VA-ECMO combined with catheter-based MT versus VA-ECMO alone. MEASUREMENTS AND MAIN RESULTS: Four observational studies (n = 2,824) met the inclusion criteria; two (n = 47) provided extractable count data for meta-analysis. Pooled odds ratios (ORs) for in-hospital mortality (0.36; 95% confidence interval [CI], 0.01-13.59) and 90-day mortality (0.43; 95% CI, 0.02-10.66) were imprecise and discordant, with very wide CIs reflecting the small number of pooled studies. A nationwide database study (n = 2,285) reported an adjusted OR of 0.75 (95% CI, 0.47-1.19) for in-hospital mortality, and an international multicenter cohort (n = 492) reported a 90-day hazard ratio of 0.68 (95% CI, 0.45-1.03) with early mechanical reperfusion; neither of the two more methodologically rigorous studies reached statistical significance. Hospital and intensive care unit lengths of stay were shorter in the ECMO-MT group, while major bleeding did not differ between groups. The certainty of evidence was very low for all mortality outcomes. CONCLUSIONS: Comparative outcome data on adding MT to VA-ECMO for high-risk PE remain scarce. Pooled estimates were imprecise, and the most methodologically robust studies available did not establish a statistically significant mortality benefit. The pooled estimates should therefore be interpreted as exploratory and hypothesis generating. Given the practical and ethical barriers to randomized trials in this critically ill population, well-designed multicenter registries with standardized outcome definitions represent the most realistic path to higher-quality evidence.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.