This retrospective cohort included 117 ICU patients with suspected high-risk pulmonary embolism across four ECMO centers during 2013–2024. ECMO recipients had numerically lower in-hospital mortality than thrombolysis recipients, but the unadjusted difference was not significant (33/79, 41.8% versus 22/38, 57.9%; P=0.15). In multivariable Cox analysis, ECMO was associated with lower in-hospital mortality (HR 0.45, 95% confidence interval 0.25–0.79; P=0.006). Kaplan–Meier analysis also favored ECMO for 28-day survival (log-rank P=0.041). Among ECMO recipients with CTPA-confirmed high-risk pulmonary embolism, 34/63 (54.0%) survived to discharge.
ECMO was associated with better adjusted survival outcomes, but the unadjusted mortality comparison was inconclusive. These observational findings do not establish superiority or safety over thrombolysis.
Study limitation: Retrospective treatment selection leaves potential residual confounding, and pulmonary embolism was not CTPA-confirmed in all enrolled patients.
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