{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:39:48Z","timestamp":1789925988910,"version":"4.0.1"},"reference-count":70,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Massive pulmonary embolism (MPE) carries significant 30-day mortality and is characterized by acute right ventricular failure, hypotension, and hypoxia, leading to cardiovascular collapse and cardiac arrest. Given the continued high mortality associated with MPE, there has been ongoing interest in utilizing extracorporeal membrane oxygenation (ECMO) to provide oxygenation support to improve hypoxia and offload the right ventricular (RV) pressure in the belief that rapid reduction of hypoxia and RV pressure will improve outcomes. Two modalities can be employed: Veno-arterial-ECMO is a reliable process to decrease RV overload and improve RV function, thus allowing for hemodynamic stability and restoration of tissue oxygenation. Veno-venous ECMO can support oxygenation but is not designed to help circulation. Several societal guidelines now suggest using ECMO in MPE with interventional therapy. There are three strategies for ECMO utilization in MPE: bridge to definitive interventional therapy, sole therapy, and recovery after interventional treatment. The use of ECMO in MPE has been associated with lower mortality in registry reviews, but there has been no significant difference in outcomes between patients treated with and without ECMO in meta-analyses. Considerable heterogeneity in studies is a significant weakness of the available literature. Applying ECMO is also associated with substantial multisystem morbidity due to a systemic inflammatory response, hemorrhagic stroke, renal dysfunction, and bleeding, which must be factored into the outcomes. The application of ECMO in MPE should be combined with an aggressive pulmonary interventional program and should strictly adhere to the current selection criteria.<\/jats:p>","DOI":"10.3389\/fcvm.2023.1298686","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T23:25:55Z","timestamp":1703114755000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":25,"title":["Current status of ECMO for massive pulmonary embolism"],"prefix":"10.3389","volume":"10","author":[{"given":"Mark G.","family":"Davies","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph P.","family":"Hart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e016784","DOI":"10.1161\/JAHA.120.016784","article-title":"Time trends in pulmonary embolism mortality rates in the United States, 1999 to 2018","volume":"9","author":"Martin","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1160\/TH08-06-0356","article-title":"Predictors of mortality from pulmonary embolism and their influence on clinical management","volume":"100","author":"Becattini","year":"2008","journal-title":"Thromb Haemost"},{"key":"B3","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1253\/circj.68.816","article-title":"Inferior vena cava filter is a new additional therapeutic option to reduce mortality from acute pulmonary embolism","volume":"68","author":"Sakuma","year":"2004","journal-title":"Circ J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1016\/s0735-1097(97)00319-7","article-title":"Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry","volume":"30","author":"Kasper","year":"1997","journal-title":"J Am Coll Cardiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s11239-012-0709-7","article-title":"Prognostic significance of multidetector computed tomography in normotensive patients with pulmonary embolism: rationale, methodology and reproducibility for the PROTECT study","volume":"34","author":"Jim\u00e9nez","year":"2012","journal-title":"J Thromb Thrombolysis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1016\/j.jacc.2010.05.071","article-title":"Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (multicenter emergency medicine pulmonary embolism in the real world registry)","volume":"57","author":"Pollack","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1016\/j.thromres.2012.08.292","article-title":"Clinical features and short term outcomes of patients with acute pulmonary embolism. 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