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Objectives <p>The impact of preoperative veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support on outcomes of emergent pulmonary embolectomy for acute pulmonary embolism (PE) remains unclear. This study evaluated the safety and efficacy of preoperative VA-ECMO in patients undergoing emergent surgical embolectomy for high-risk PE.</p> Methods <p>Between December 2007 and September 2025, 38 consecutive patients underwent emergent pulmonary embolectomy for acute PE. Patients were divided into two groups: without preoperative VA-ECMO (Group A, n = 17) and with preoperative VA-ECMO (Group B, n = 21). The primary outcome was a composite of in-hospital mortality and cardiopulmonary arrest (CPA) during anesthesia induction. Secondary outcomes included postoperative complications and long-term survival. Kaplan–Meier analysis was used to compare survival.</p> Results <p>Baseline characteristics were comparable between groups. Four patients in Group A (23.5%) experienced the primary outcome versus none in Group B (0%, <i>p</i> = 0.032). In-hospital mortality was 17.7% in Group A versus 0% in Group B (<i>p</i> = 0.081). Postoperative complications were similar between groups. The mean follow-up period was 55.0 ± 50.1&#xa0;months. Five-year overall survival was significantly lower in Group A (62.4%) than in Group B (94.4%, log-rank <i>p</i> = 0.012).</p> Conclusions <p>Preoperative VA-ECMO support was safe, and was associated with a lower incidence of hemodynamic collapse during anesthesia induction and better early and long-term survival. Consideration of preoperative VA-ECMO support should be given to improve early and long-term survival.</p>

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Preoperative extracorporeal membrane oxygenation is associated with improved outcomes in emergent surgical pulmonary embolectomy

  • 期刊论文

  • 发表日期：

    2026年7月21日

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  • Hidefumi Nishida,
  • Ryota Nakamura,
  • Rihito Tamaki,
  • Kohei Abe

摘要

Objectives

The impact of preoperative veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support on outcomes of emergent pulmonary embolectomy for acute pulmonary embolism (PE) remains unclear. This study evaluated the safety and efficacy of preoperative VA-ECMO in patients undergoing emergent surgical embolectomy for high-risk PE.

Methods

Between December 2007 and September 2025, 38 consecutive patients underwent emergent pulmonary embolectomy for acute PE. Patients were divided into two groups: without preoperative VA-ECMO (Group A, n = 17) and with preoperative VA-ECMO (Group B, n = 21). The primary outcome was a composite of in-hospital mortality and cardiopulmonary arrest (CPA) during anesthesia induction. Secondary outcomes included postoperative complications and long-term survival. Kaplan–Meier analysis was used to compare survival.

Results

Baseline characteristics were comparable between groups. Four patients in Group A (23.5%) experienced the primary outcome versus none in Group B (0%, p = 0.032). In-hospital mortality was 17.7% in Group A versus 0% in Group B (p = 0.081). Postoperative complications were similar between groups. The mean follow-up period was 55.0 ± 50.1 months. Five-year overall survival was significantly lower in Group A (62.4%) than in Group B (94.4%, log-rank p = 0.012).

Conclusions

Preoperative VA-ECMO support was safe, and was associated with a lower incidence of hemodynamic collapse during anesthesia induction and better early and long-term survival. Consideration of preoperative VA-ECMO support should be given to improve early and long-term survival.