{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T12:23:15Z","timestamp":1782476595088,"version":"3.54.5"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"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>\n                    Pulmonary embolism (PE) presenting with syncope as an initial symptom is a relatively uncommon condition with a comparatively high rate of mortality (47.5%) that is prone to misdiagnosis as other cardiac and pulmonary diseases. The European Society of Cardiology classifies acute PE with persistent hypotension as high-risk PE. Patients with syncope as the initial symptom often have persistent hypotension and hypoxemia. Although traditional therapeutic approaches, such as thrombolysis and anticoagulation, have limited efficacy in treating this type of acute PE, timely use of extracorporeal membrane oxygenation (ECMO) to stabilize hemodynamics and bridging with percutaneous pulmonary thrombectomy (PPT), is an effective method in cases of high-risk PE presenting with syncope as the initial symptom. In this report, we describe the case of a 48-year-old man with no history of previous cardiac or pulmonary diseases, who had experienced sudden syncope 3 days prior to admission. Following admission, he developed cardiogenic shock [heart rate 125\u2005beats per min, systolic blood pressure (SBP) 87\u2005mmHg, lactate 5.2\u2005mmol\/L]. Computed tomography pulmonary angiography revealed massive bilateral PE. Although thrombolytic therapy was promptly administered, the patient continued to experience persistent hypotension (SBP 67\u2005mmHg) and refractory hypoxemia (SaO\n                    <jats:sub>2<\/jats:sub>\n                    73%). ECMO was initiated, achieving hemodynamic stabilization within 30\u2005min (SBP 95\u2005mmHg, SaO\n                    <jats:sub>2<\/jats:sub>\n                    99%). Echocardiography revealed right ventricular dysfunction. To reduce pulmonary artery pressure and prevent further right heart failure, we performed emergency PPT under ECMO support. The patient was discharged on day 14 with no neurological deficits. This case highlights the efficacy of ECMO as a bridge to definitive therapy, combined with prompt PPT, in the management of high-risk PE with hemodynamic collapse. The successful outcome in this case emphasizes the importance of structured, protocol-driven hemodynamic support using ECMO and timely surgical intervention in preventing right ventricular failure.\n                  <\/jats:p>","DOI":"10.3389\/fcvm.2026.1800854","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:52:03Z","timestamp":1774421523000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Successful rescue of a high-risk pulmonary embolism using thrombolysis, extracorporeal membrane oxygenation, and percutaneous pulmonary thrombectomy: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Xia","family":"Meng","sequence":"first","affiliation":[{"name":"Department of Cardiology, China-Japan Union Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongsheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, China-Japan Union Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guohui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, China-Japan Union Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Cardiology, China-Japan Union Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1161\/circulationaha.105.592592","article-title":"Massive pulmonary embolism","volume":"113","author":"Kucher","year":"2006","journal-title":"Circulation"},{"key":"B2","first-page":"3","article-title":"Syncope in acute pulmonary embolism","volume":"5","author":"Morpurgo","year":"2004","journal-title":"Ital Heart J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1177\/2048872614527837","article-title":"Value of syncope in patients with high-to-intermediate risk pulmonary artery embolism","volume":"4","author":"Duplyakov","year":"2015","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1093\/eurheartj\/ehn208","article-title":"Prognostic value of right ventricular dysfunction in 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studies","volume":"41","author":"Yang","year":"2025","journal-title":"Pak J Med Sci"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e1573403X339627","DOI":"10.2174\/011573403X339627241224085451","article-title":"The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for acute high risk pulmonary embolism: a systematic review","volume":"21","author":"Munagala","year":"2025","journal-title":"Curr Cardiol Rev"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2025.11.005","article-title":"2026 AHA\/ACC\/ACCP\/ACEP\/CHEST\/SCAI\/SHM\/SIR\/SVM\/SVN guideline for the evaluation and management of acute pulmonary embolism in adults: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","author":"Creager","year":"2026","journal-title":"J Am Coll Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e512","DOI":"10.1097\/ccm.0000000000006361","article-title":"Extracorporeal membrane oxygenation and reperfusion strategies in high-risk pulmonary embolism hospitalizations","volume":"52","author":"Farmakis","year":"2024","journal-title":"Crit Care Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1177\/08850666231178262","article-title":"Use of perioperative extracorporeal membranous oxygenation in pulmonary endarterectomy cases: a systematic review and meta-analysis","volume":"38","author":"Ishisaka","year":"2023","journal-title":"J Intensive Care Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"8004","DOI":"10.3390\/jcm14228004","article-title":"Evolving management of acute pulmonary embolism with extracorporeal membrane oxygenation-A narrative review","volume":"14","author":"Hart","year":"2025","journal-title":"J Clin 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