{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T08:25:06Z","timestamp":1787214306269,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"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>Interventional treatment for hemodynamically unstable pulmonary embolism (PE) is now common due to the fact that unstable PE carries a significant 30-day mortality. Unstable PE is characterized by acute right ventricular failure, hypotension, and hypoxia, leading to cardiovascular collapse and cardiac arrest. Implementation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) acutely provides oxygenation support to improve hypoxia and offload the right ventricular (RV) pressure in the belief that rapid reduction of hypoxia and right ventricular (RV) pressure will provide a window for intervention. There are two strategies for using VA-ECMO during percutaneous pulmonary mechanical thrombectomy: VA-ECMO-assisted mechanical thrombectomy and mechanical thrombectomy with standby VA-ECMO. While the application of VA-ECMO in percutaneous mechanical thrombectomy is usually short-term, providers must be cognizant that it can be associated with substantial multisystem morbidity due to a systemic inflammatory response, hemorrhagic stroke, renal dysfunction, and bleeding, and these factors will impact outcomes. The evolving paradigm positions VA-ECMO combined with percutaneous pulmonary mechanical thrombectomy as the preferred combination for the high-risk PE patients (acute right ventricular failure, refractory shock, and cardiac arrest), while percutaneous pulmonary mechanical thrombectomy alone with standby VA-ECMO suffices for most intermediate PE patients.<\/jats:p>","DOI":"10.3389\/fcvm.2026.1935374","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T08:05:02Z","timestamp":1787213102000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Role of ECMO and percutaneous mechanical thrombectomy in the management of acute pulmonary embolism"],"prefix":"10.3389","volume":"13","author":[{"given":"Mark G.","family":"Davies","sequence":"first","affiliation":[{"name":"Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases","place":["Houston, TX, United States"]},{"name":"Department of Vascular and Endovascular Surgery, Ascension Health","place":["Waco, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph P.","family":"Hart","sequence":"additional","affiliation":[{"name":"Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases","place":["Houston, TX, United States"]},{"name":"Division of Vascular Surgery, Medical College of Wisconsin","place":["Milwaukee, WI, United States"]},{"name":"Clement J. 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