{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:44:01Z","timestamp":1791477841611,"version":"4.3.4"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore how early mechanical reperfusion impacts outcomes in high-risk pulmonary embolism (PE) patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2009hours of ECMO initiation. Patients dying within 12\u2009hours or receiving delayed reperfusion were excluded. The primary outcome was 90-day mortality, assessed using propensity-matched groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>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\u2009=\u2009.07). 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\u2009=\u2009.04). Bleeding occurred in 50% of patients, with no significant difference between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajrccm\/aamaf116","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T12:18:16Z","timestamp":1767615496000},"page":"474-486","source":"Crossref","is-referenced-by-count":4,"title":["Early mechanical reperfusion in high-risk pulmonary embolism supported by venoarterial extracorporeal membrane oxygenation: a multicenter international cohort study"],"prefix":"10.1093","volume":"212","author":[{"given":"David","family":"Levy","sequence":"first","affiliation":[{"name":"Service de M\u00e9decine Intensive-R\u00e9animation, Institut de Cardiologie, Assistance Publique\u2013H\u00f4pitaux de Paris, Sorbonne Universit\u00e9, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re , Paris,","place":["France"]},{"name":"Sorbonne Universit\u00e9, Inserm, Unit\u00e9 de Recherche sur les Maladies Cardiovasculaires et M\u00e9taboliques_1166-ICAN, Institute of Cardiometabolism and Nutrition , Paris,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Petit","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Ambroise Par\u00e9 Hospital, Assistance Publique\u2013H\u00f4pitaux de Paris, Boulogne-Billancourt, Inserm, U1018, Centre de Recherche en \u00e9pid\u00e9miologie et Sant\u00e9 des Populations, University Versailles Saint Quentin\u2013University Paris Saclay , Guyancourt,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Assouline","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Geneva University Hospitals , 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