The utilization of large bore mechanical thrombectomy and extracorporeal pulmonary resuscitation in catastrophic pulmonary embolism: A case series.

BackgroundThe combined use of extracorporeal cardio-pulmonary resuscitation (ECPR) and large bore mechanical thrombectomy represents an emerging strategy for patients experiencing cardiac arrest secondary to catastrophic pulmonary embolism.MethodsThis retrospective, single-center study included patients treated between January 2023 and June 2025 who experienced cardiac arrest due to catastrophic pulmonary embolism and underwent ECPR followed by large bore mechanical thrombectomy. Primary outcomes were 90-days post-discharge survival and cerebral performance category (CPC) at discharge. Secondary outcomes included support duration, complications during support, and ICU and hospital length of stay.ResultsFifteen patients were included. Four (27%) sustained out-of-hospital cardiac arrest, and twelve (80%) presented with pulseless electrical activity. All patients underwent large bore mechanical thrombectomy using the Inari FlowTriever System (Inari Medical, Irvine, CA) within 6 hours of arrest in the cardiac catheterization laboratory. Eight patients (53%) survived to discharge with favorable neurological outcomes (CPC 1-2). Seven patients died following withdrawal of care due to cerebrovascular accident or anoxic brain injury (n = 4), intracranial hemorrhage (n = 2), or mesenteric ischemia (n = 1). Cerebrovascular or anoxic brain injury occurred more frequently among non-survivors (p = 0.02). No significant differences were observed in baseline characteristics, ECMO or ventilator duration, or length of stay between survivors and non-survivors.ConclusionECPR followed by large bore mechanical thrombectomy is a feasible resuscitative strategy for patients presenting with catastrophic pulmonary embolism. Larger, multicenter studies are warranted to better define outcomes and the overall impact of this combined approach.