{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:54:14Z","timestamp":1791219254620,"version":"4.1.0"},"reference-count":36,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T00:00:00Z","timestamp":1627603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Massive acute pulmonary embolism (MAPE) with obstructive cardiogenic shock is associated with a mortality rate of more than 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in refractory cardiogenic shock with very good results. In MAPE, although it is currently recommended as part of initial resuscitation, it is not yet considered a stand-alone therapy. Material and Methods: All patients with MAPE requiring the establishment of VA-ECMO and admitted to our tertiary intensive care unit were analysed over a period of 10 years. The characteristics of these patients, before, during and after ECMO were extracted and analysed. Results: A total of 36 patients were included in the present retrospective study. Overall survival was 64%. In the majority of cases, the haemodynamic and respiratory status of the patient improved significantly within the first 24 h on ECMO. The 30-day survival significantly increased when ECMO was used as stand-alone therapy (odds ratio (OR) 15.58, 95% confidence interval (CI) 2.65\u201391.57, p = 0.002). Nevertheless, when ECMO was implanted following the failure of thrombolysis, the bleeding complications were major (17 (100%) vs. 1 (5.3%) patients, p &lt; 0.001) and the 30-day mortality increased significantly (OR 0.11, 95% CI 0.022\u20130.520, p = 0.006). Conclusions: The present retrospective study is certainly one of the most important in terms of the number of patients with MAPE and shock treated with VA-ECMO. This short-term mechanical circulatory support, used as a stand-alone therapy in MAPE, allows for the optimal stabilisation of patients.<\/jats:p>","DOI":"10.3390\/jcm10153376","type":"journal-article","created":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T03:46:42Z","timestamp":1627616802000},"page":"3376","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5956-8643","authenticated-orcid":false,"given":"Rapha\u00ebl","family":"Giraud","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland"},{"name":"Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Laurencet","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Assouline","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland"},{"name":"Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amandine","family":"De Charri\u00e8re","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland"},{"name":"Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Banfi","sequence":"additional","affiliation":[{"name":"Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland"},{"name":"Department of Cardio-Thoracic Surgery Istituto Clinico Sant\u2019Ambrogio, Gruppo Ospedaliero San Donato, Milan, and Chair of Cardiac Surgery, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7921-7207","authenticated-orcid":false,"given":"Karim","family":"Bendjelid","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland"},{"name":"Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1161\/CIRCULATIONAHA.105.592592","article-title":"Massive pulmonary embolism","volume":"113","author":"Kucher","year":"2006","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4196","DOI":"10.1093\/eurheartj\/ehy464","article-title":"Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: A multicentre series of 52 cases","volume":"39","author":"Meneveau","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/MCC.0000000000000747","article-title":"The place of extracorporeal life support in cardiogenic shock","volume":"26","author":"Brechot","year":"2020","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/MCC.0000000000000717","article-title":"Extracorporeal cardiopulmonary resuscitation for cardiac arrest","volume":"26","author":"Kalra","year":"2020","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e461","DOI":"10.1016\/j.ajem.2012.08.043","article-title":"Extracorporeal membrane oxygenation support as bridge to recovery in a patient with electrical storm related cardiogenic shock","volume":"31","author":"Brunner","year":"2013","journal-title":"Am. J. Emerg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E495","DOI":"10.21037\/jtd.2016.06.26","article-title":"Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients","volume":"8","author":"Pozzi","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_8","first-page":"570","article-title":"Extracorporeal life support for massive pulmonary embolism","volume":"62","author":"Maggio","year":"2007","journal-title":"J. Trauma"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s13054-017-1655-8","article-title":"Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation","volume":"21","author":"Corsi","year":"2017","journal-title":"Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.jvsv.2020.04.033","article-title":"Venoarterial extracorporeal membrane oxygenation is an effective management strategy for massive pulmonary embolism patients","volume":"9","author":"Guliani","year":"2020","journal-title":"J. Vasc. Surg. Venous Lymphat Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2017.11.034","article-title":"A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support","volume":"122","author":"George","year":"2018","journal-title":"Resuscitation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1177\/0267659115583377","article-title":"Extracorporeal membrane oxygenation in acute massive pulmonary embolism: A systematic review","volume":"30","author":"Yusuff","year":"2015","journal-title":"Perfusion"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e000735","DOI":"10.1136\/openhrt-2017-000735","article-title":"Understanding haemorrhagic risk following thrombolytic therapy in patients with intermediate-risk and high-risk pulmonary embolism: A hypothesis paper","volume":"5","author":"Abraham","year":"2018","journal-title":"Open Heart"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1007\/s10877-015-9796-2","article-title":"Massive pulmonary embolism leading to cardiac arrest: One pathology, two different ECMO modes to assist patients","volume":"30","author":"Giraud","year":"2015","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1111\/aas.12411","article-title":"Peri-operative massive pulmonary embolism management: Is veno-arterial ECMO a therapeutic option?","volume":"58","author":"Pavlovic","year":"2014","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3033","DOI":"10.1093\/eurheartj\/ehu283","article-title":"2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism","volume":"35","author":"Konstantinides","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E875","DOI":"10.21037\/jtd.2016.09.25","article-title":"Veno-arterial extracorporeal membrane oxygenation: An overview of different cannulation techniques","volume":"8","author":"Banfi","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_18","first-page":"2368","article-title":"[\u201cMobile\u201d ECMO]","volume":"10","author":"Moret","year":"2014","journal-title":"Rev. Med. Suisse"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1056\/NEJM199311253292204","article-title":"The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction","volume":"329","author":"Investigators","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3639","DOI":"10.1378\/chest.128.5.3639","article-title":"Right atrial pressure: Determinant or result of change in venous return?","volume":"128","author":"Bendjelid","year":"2005","journal-title":"Chest"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1161\/CIR.0b013e318214914f","article-title":"Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: A scientific statement from the American Heart Association","volume":"123","author":"Jaff","year":"2011","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"365","DOI":"10.4103\/2045-8932.87302","article-title":"Blood flow redistribution and ventilation-perfusion mismatch during embolic pulmonary arterial occlusion","volume":"1","author":"Burrowes","year":"2011","journal-title":"Pulm. Circ."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1097\/MCC.0000000000000660","article-title":"Massive pulmonary embolism: Embolectomy or extracorporeal membrane oxygenation?","volume":"25","author":"Tahir","year":"2019","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1055\/s-0036-1597559","article-title":"Massive Pulmonary Embolism: Extracorporeal Membrane Oxygenation and Surgical Pulmonary Embolectomy","volume":"38","author":"Weinberg","year":"2017","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.hrtlng.2016.11.005","article-title":"Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism","volume":"46","author":"Dolmatova","year":"2017","journal-title":"Heart Lung"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1177\/0267659115583682","article-title":"Extracorporeal life support (ECLS) for cardiopulmonary resuscitation (CPR) with pulmonary embolism in surgical\u2014A case series","volume":"31","author":"Swol","year":"2016","journal-title":"Perfusion"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1016\/S0140-6736(98)07534-5","article-title":"Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)","volume":"353","author":"Goldhaber","year":"1999","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/S0002-9343(98)00355-6","article-title":"Incidence and predictors of major hemorrhagic complications from thrombolytic therapy in patients with massive pulmonary embolism","volume":"105","author":"Meyer","year":"1998","journal-title":"Am. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1093\/eurheartj\/ehu218","article-title":"Systemic thrombolytic therapy for acute pulmonary embolism: A systematic review and meta-analysis","volume":"36","author":"Marti","year":"2015","journal-title":"Eur. Heart J"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/BF01062714","article-title":"Streptokinase and Heparin versus Heparin Alone in Massive Pulmonary Embolism: A Randomized Controlled Trial","volume":"2","author":"Valencia","year":"1995","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1097\/CCM.0000000000004828","article-title":"Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review","volume":"49","author":"Scott","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1378\/chest.13-1562","article-title":"A multidisciplinary pulmonary embolism response team","volume":"144","author":"Kabrhel","year":"2013","journal-title":"Chest"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1016\/j.amjcard.2019.07.043","article-title":"Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes","volume":"124","author":"Chaudhury","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/0267659118786830","article-title":"Extracorporeal membrane oxygenation in acute massive pulmonary embolism: A case series and review of the literature","volume":"34","author":"Rosenfield","year":"2019","journal-title":"Perfusion"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.resuscitation.2015.07.016","article-title":"European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support","volume":"95","author":"Soar","year":"2015","journal-title":"Resuscitation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.athoracsur.2017.08.033","article-title":"Utilization of Veno-Arterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism","volume":"105","author":"Pasrija","year":"2018","journal-title":"Ann. Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/15\/3376\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:37:09Z","timestamp":1760164629000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/15\/3376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,30]]},"references-count":36,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["jcm10153376"],"URL":"https:\/\/doi.org\/10.3390\/jcm10153376","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,30]]}}}