Early mechanical reperfusion in high-risk pulmonary embolism supported by venoarterial extracorporeal membrane oxygenation: a multicenter international cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: To explore how early mechanical reperfusion impacts outcomes in high-risk pulmonary embolism (PE) patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). METHODS: This retrospective international study included adult patients treated with VA-ECMO for high-risk PE at 39 ECMO centers (2014-2024). Early mechanical reperfusion was defined as catheter-directed therapy or surgical embolectomy within 48 hours of ECMO initiation. Patients dying within 12 hours or receiving delayed reperfusion were excluded. The primary outcome was 90-day mortality, assessed using propensity-matched groups. MEASUREMENTS AND MAIN RESULTS: Among 492 patients on VA-ECMO (median age, 53 years), 69% had cardiac arrest, and 28% received early mechanical reperfusion. After propensity matching, 137 patients were compared in each group. Ninety-day mortality was 32% with early mechanical reperfusion on ECMO versus 39% with ECMO stand-alone (HR, 0.68 [95% CI, 0.45-1.03]; P = .07). Overall, ECMO duration and weaning rates were similar; however, early mechanical reperfusion improved ECMO weaning in patients without prior thrombolysis (subdistribution HR, 1.56 [95% CI, 1.03-2.36]; P = .04). Bleeding occurred in 50% of patients, with no significant difference between groups. CONCLUSIONS: In this large international cohort of patients with high-risk PE on VA-ECMO, early mechanical reperfusion therapy was not associated with a reduction in 90-day mortality or ECMO duration. These findings may support a stepwise, individualized approach favoring initial ECMO stand-alone support, although a certain clinical benefit from early mechanical reperfusion in selected patients cannot be excluded.
Authors: David Levy, Matthieu Petit, Benjamin Assouline, Alexander Dietl, Guillaume Lebreton, Raphaël Giraud, Joshua Ihle, Paul Masi, Sally Newman, Anna Condella, Jordi Riera, Marc Pierrot, Alexandre Mansour, Shinichiro Ohshimo, Lise Thellier, Dirk W Donker, Celine Besnard, Alice Vennier, Hadrien Winiszewski, Guido Tavazzi, Jonathan Taylor, Julien Dessajan, Philipp M Lepper, Pauline Yeung Ng, Juan I Chico, Christophe Guervilly, Louis Pot, Dieter Dauwe, Philip Fortuna, Fabio Silvio Taccone, Baptiste Compagnon, Jae-Seung Jung, Zied Ltaief, Roberto Roncon-Albuquerque, Pierre Denormandie, Marco Giani, Thibault Duburcq, Giacomo Grasselli, Hélène Nougué, Adrien Werquin, Olivier Sanchez, Antoine Beurton, Martin Balik, Marie Jungling, Maria Heinrich, Thomas Mueller, Alain Combes, Matthieu Schmidt, for the CATAPULTE Investigator Group, Juliette Chommeloux, Alain Combes, Guillaume Hekimian, David Levy, Charles-Edouard Luyt, Quentin Moyon, Grégoire Del Marmol, Marc Pineton De Chambrun, Ouriel Saura, Matthieu Schmidt, Cyril Charron, Matthieu Petit, Antoine Vieillard-Baron, François Bagate, Romain Gallet, Thierry Folliguet, Paul Masi, Armand Mekontso Dessap, Keyvan Razazi, Bernard Cholley, Hélène Nougue, Adrien Werquin, Olivier Sanchez, Olivier Pellerin, Charles-Henri Gautier, Lila Bouadma, Julien Dessajan, Etienne De Montmollin, Romain Sonneville, Michael Thy, Jean-François Timsit, Pierre Denormandie, François Stephan, Marc Gainnier, Louis Pot, Jean-Marie Forel, Ines Gragueb-Chatti, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Antoine Roch, Antoine Beurton, Julien Imbault, Quentin Lajoye, Alexandre Ouattara, Quentin Delforge, Nicolas Dognon, Thibault Duburcq, Julien Poissy, Benoit Brassard, Oliver Lukowiak, Mouhamed Djahoum Moussa, Lise Thellier, André Vincentelli, Marie Jungling, Erwan Flecher, Yoann Launey, Mathieu Lesouhaitier, Lucie Jansen, Alexandre Mansour, Nicolas Nesseler, Baptiste Compagnon, Fanny Vardon, Nicolas Meneveau, François Belon, Pierre-André Pinel, Gael Piton, Thibault Vieille, Hadrien Winiszewski, Celine Besnard, Gregoire Muller, Kamel Toufik, Emmanuel Cannet, Alice Vennier, Alain Mercat, Pierre Asfar, Satar Mortaza, Pierre-Yves Olivier, Paul Jaubert, Dieter Dauwe, Erwin Detroy, Bart Jacobs, Dirk Vlasselaers, Tom Verbelen, Bart Meyns, Filippo Annoni, Luca D’Amelio, Katarina Halenarova, Vincent Labbe, Fabio Silvio Taccone, Leda Nobile, Cleide Barrigoto, Laura Santos, Pedro Costa, Philip Fortuna, Roberto Roncon-Albuquerque, Francisco Santos-Dias, Martin Balik, Ivana Jurisinova, Jan Pudil, Isabelle Cristiani, Zied Ltaief, Filip Dulguerov, Ziyad Gunga, Anna Nowacka, Benjamin Assouline, Karim Bendjelid, Raphaël Giraud, Tammy Sin Kwan Ma, Pauline Yeung Ng, Philipp M Lepper, Vitalie Mazuru, Alexander Dietl, Maria Heinrich, Thomas Mueller, Anna Schnobrich, Jae-Seung Jung, Ji Eon Kim, Hee Jung Kim, Jun Ho Lee, Yonghoon Shim, Nicola Bottino, Alessio Caccioppola, Giacomo Grasselli, Giovanna Pedrazzini, Mirko Belliato, Costanza Colombo, Antonella Degani, Tavazzi Guido, Carlo Pellegrini, Jenelle Badulak, Anna Condella, Whitney Kiker, Luis S Chiscano Camon, Jordi Riera, Cristina Carbajales, Juan I Chico, Dorian Ciobanu, Santiago Freita, Vanesa Gomez, María D Rivas, Giuseppe Foti, Marco Giani, Matteo Pozzi, Michela Ravasi, Ghislaine Doufle, Eddy Fan, Jonathan Taylor, Mitsuaki Nishikimi, Shinichiro Ohshimo, Nobuaki Shime, Joshua Ihle, Eanna Lowney, Vincent Pellegrino, Hergen Buscher, Dirk W Donker
Institutions: Inserm, Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Unité de recherche sur les maladies cardiovasculaires et métaboliques, Fondation pour l’innovation en Cadiométabolisme et Nutrition, Centre de recherche en Epidémiologie et Santé des Populations, Hôpital Ambroise-Paré, University Hospital of Geneva, University Hospital Regensburg, The Alfred Hospital, Hôpitaux Universitaires Henri-Mondor, St Vincent's Hospital Sydney, University of Washington, Vall d'Hebron Hospital Universitari, Centre Hospitalier Universitaire d'Angers, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Université de Rennes, Hiroshima University, Université de Lille, Centre Hospitalier Universitaire de Lille, Evaluation des technologies de santé et des pratiques médicales, Utrecht University, University Medical Center Utrecht, Centre hospitalier universitaire d'Orléans, Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes Université, Centre Hospitalier Universitaire de Besançon, Policlinico San Matteo Fondazione, University of Toronto, Université Paris Cité, Hôpital Bichat-Claude-Bernard, Universitätsklinikum des Saarlandes, Saarland University, University of Hong Kong, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Hôpital de la Timone, Universitair Ziekenhuis Leuven, Unidade Local de Saúde de São José, Hospital de São José, Université Libre de Bruxelles, Centre Hospitalier Universitaire de Toulouse, Hôpital Rangueil, Korea University Anam Hospital, Centre Hospitalier Universitaire Vaudois, Hospital de São João, Hôpital Marie Lannelongue, University of Milano-Bicocca, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Hôpital Européen Georges-Pompidou, Paris Cardiovascular Research Center, French Clinical Research Infrastructure Network, Centre Hospitalier Universitaire de Bordeaux, Charles University, General University Hospital in Prague
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: green
OpenAlex ID: W7125604170