Efficacy of ECMO in Managing Suspected Fatal High-Risk Pulmonary Embolism and Prognostic Risk Factors in Confirmed Patients: An 11-Year Multicenter Retrospective Cohort Study

Efficacy of ECMO in Managing Suspected Fatal High-Risk Pulmonary Embolism and Prognostic Risk Factors in Confirmed Patients: An 11-Year Multicenter Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy of ECMO in Managing Suspected Fatal High-Risk Pulmonary Embolism and Prognostic Risk Factors in Confirmed Patients: An 11-Year Multicenter Retrospective Cohort Study Liusheng Hou, Chang zhi Liu, Zhanguo Liu, Lihan Shen, Chunlai Fu, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6513648/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose For patients with suspected fatal high-risk pulmonary embolism (PE) who cannot undergo computed tomography pulmonary angiography (CTPA), should ECMO rescue be prioritized over pulmonary vascular revascularization? What is the optimal revascularization strategy for patients under ECMO? What are the key risk factors affecting prognosis? This study addresses these questions to improve outcomes in high-risk PE. Methods Clinical data of 143 patients with suspected fatal high-risk PE admitted to five ECMO centers (January 2013-January 2024) were retrospectively analyzed. Results 1. Of 143 patients, 79 initially received ECMO (ECMO group), whereas 64 received revascularization (non-ECMO group). The baseline characteristics were similar between the two groups. However, the 28-Day mortality rate was lower in the ECMO group (49.4%, 39/79) than in the non-ECMO group (71.9%, 46/64; P < 0.05). 2. Among 79 ECMO-treated patients, CTPA confirmed PE in 63. Successful ECMO weaning rate was 58.7% (37/63), ECMO duration was 3.7 ± 3.3 days, and the survival to discharge was 54.0% (34/63). 3. Comparisons among ECMO + surgical thrombectomy, ECMO + thrombolysis, and ECMO alone groups showed the lowest 28-Day mortality with ECMO + surgical thrombectomy (9.1% vs 50.0% vs 52.5%, P < 0.05). 4. Logistic Regression Analysis identified the time from shock to ECMO as an independent risk factor affecting prognosis ( P < 0.05). Conclusions For patients with suspected fatal high-risk PE, treating the primary disease under ECMO reduces mortality. Surgical thrombectomy may be considered for eligible patients. The time from shock to ECMO is an important factor affecting prognosis in confirmed cases. Extracorporeal Membrane Oxygenation High-Risk Pulmonary Embolism Pulmonary Vascular Revascularization Prognosis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Background High-risk PE is characterized by a low incidence but rapid progression, frequently resulting in obstructive shock, cardiac arrest, and an extremely high mortality [ 1 , 2 ]. Early identification and timely intervention are crucial for improving patient outcomes. According to guidelines from European societies, pulmonary vascular revascularization should be initiated promptly in suspected high-risk PE patients who are unable to undergo CTPA [ 3 , 4 ]. However, in clinical practice, while some patients benefit from guideline-recommended management, there are the risks of misdiagnosis and inappropriate treatment persist in suspected cases, and selecting the most appropriate pulmonary revascularization strategies remains challenging. For instance, in suspected patients contraindicated for thrombolysis, the lack of a preoperative CTPA scan can increase surgical complexity and may result in missed opportunities for surgical intervention. ECMO provides robust cardiopulmonary support. Case series studies demonstrate that ECMO is an effective circulatory support modality for patients with high-risk PE, with some patients achieving favorable outcomes [ 5 , 6 , 7 ]. However, large-scale studies report a treatment success rate ranging from 38–50% [ 8 , 9 , 10 ]. Improving survival rates in high-risk PE patients remains a focus of ongoing research. ECMO for managing high-risk PE was first implemented in the Pearl River Delta region in China. Our protocol involves initiating ECMO for some suspected, potentially fatal, cases of prior to pulmonary vascular revascularization. CTPA is performed under ECMO to confirm the diagnosis, followed by targeted therapeutic interventions (Fig. 1 ). To date, no clinical studies have systematically revealed whether this strategy enhances survival rates in patients with suspected cases. We retrospectively analyzed the clinical data of patients diagnosed with suspected fatal High-risk PE during hospitalization at five high-volume ECMO centers in Guangdong's Pearl River Delta region. Our study focused on addressing the following key questions: 1) Does ECMO improve survival rates in these patients? 2) What is the optimal strategy for pulmonary vascular revascularization under ECMO? 3) What are the risk factors influencing the prognosis of fatal high-risk PE in patients receiving ECMO? and 4) Is there a correlation between the severity of pulmonary artery thrombus obstruction and patient outcomes? The aim of this research is to increase the treatment success rate for patients with suspected fatal high-risk PE. 2. Methods 2.1 Case collection and treatment processes 2.1.1 Case collection Patients who were diagnosed with suspected fatal high-risk PE at five high-volume ECMO centers in Guangdong's Pearl River Delta region between January 2013 and January 2024 were included in this study. Patients who did not receive ECMO or pulmonary vascular revascularization treatment were excluded from the analysis. Suspected fatal high-risk PE was defined as persistent systolic blood pressure (SBP) below 90 mmHg despite the use of ≥ 2 vasoactive drugs, or repeated episodes of cardiac arrest. Patients with suspected high-risk PE were diagnosed in accordance with the European Society of Cardiology guidelines [ 4 ]. In accordance with current China legislation, informed consent was not required for the retrospective analysis of data routinely collected in the medical files. This study was approved by the Ethics Committee on Clinical Scientific Research and Laboratory Animal of Zhongshan Peoples’s Hospital (approval no. 2025-031). 2.1.2 Treatment Strategies and Grouping Patients with suspected fatal high-risk PE were divided into two groups: The ECMO group and the non-ECMO group, based on whether ECMO was initiated first. The strategies are as follows: 1) ECMO group: ECMO was initiated, followed by diagnosis of the underlying condition and selection of a targeted treatment strategies. 2) non-ECMO group: Pulmonary vascular recanalization via intravenous thrombolysis, heparin anticoagulation, or interventional thrombectomy was performed first. High-risk PE patients on ECMO were divided into two groups by discharge outcome: survival group and death group. Based on pulmonary vascular recanalization therapy, they were further grouped into three subgroups: ECMO alone, ECMO + thrombolysis, ECMO + surgical thrombectomy. 2.2 ECMO Intervention Timing, Circuit Establishment, and Management Strategies 2.2.1 Criteria for ECMO Initiation For patients with suspected fatal high-risk PE, emergency VA-ECMO should be initiated under the following conditions: 1) SBP remains < 90 mmHg despite ≥ 2 vasoactive drugs; 2) Cardiac arrest occurs and spontaneous circulation is not restored after 10 minutes of cardiopulmonary resuscitation (CPR); or 3) Spontaneous circulation is restored but persistent shock and recurrent cardiac arrest occur despite continued high-dose vasoactive support. 2.2.2 Establishment of the ECMO circuit The peripheral VA-ECMO circuit was inserted under anesthesia by an experienced vascular surgeon, utilizing Medtronic and Maquet devices. It was established via percutaneous femoral arteriovenous incision or puncture with 19-21Fr venous drainage and 17-19Fr arterial return cannulas. Bypass grafts were routinely placed in percutaneous cases to prevent distal ischemia. 2.2.3 ECMO management strategy Circulatory Support: The ECMO flow rate was set at 2.0–4.0 L/min, and a MAP > 65 mmHg was maintained through preload optimization and vasopressor administration. Respiratory Support: Lung-protective ventilation was implemented to maintain SpO₂> 92% and PaCO₂ 35–45 mmHg. Anticoagulation Management: Unfractionated heparin was administered to ensure that the ACT 180–220 s, and the APTT 50–80 s. Criteria for ECMO Weaning: 1) Resolution or mitigation of the mechanical or functional causes of pulmonary hypertension. 2) Hemodynamic stability and reduced right atrial/ventricular dimensions and tricuspid regurgitation on transthoracic echocardiograph. 3) Hemodynamic stability after ECMO flow rate is gradually decreased to 0.5 L/min over the course of 1–2 hours. 2.3 Assessment of Pulmonary Vascular Obstruction Severity and Revascularization therapy Evaluation of Pulmonary Vascular Obstruction Severity: The severity of pulmonary artery thrombus obstruction was quantified using the Qanadli scoring system [ 11 ], based on the findings from CTPA. Higher scores indicate more severe obstruction, with a maximum score of 40. Principles of Pulmonary Vascular revascularization Treatment: 1) Surgical intervention: For patients who were suitable for surgery, perform surgical thrombectomy under cardiopulmonary bypass. 2) Pharmacological therapy: For patients unsuitable for surgery, anticoagulation therapy or thrombolysis was performed. 2.4 Data collection Participants were followed up post-discharge via telephone at two predefined time points: 3 months and 6 months. The baseline characteristics of patients, including sex, age, BMI, comorbidities, and risk factors for deep vein thrombosis (DVT), were recorded. For the ECMO group, pre-ECMO data, including APACHE II scores, vasoactive inotropic scores (VIS), hemodynamic parameters, transthoracic echocardiography findings, and arterial blood gas measurements, were obtained. For the non-ECMO group, clinical data was collected prior to pulmonary vascular revascularization therapy. For high-risk PE patients receiving ECMO, clinical information, including APACHE II scores, VIS, hemodynamic parameters, reperfusion strategies employed, 28-day all-cause mortality rates, and causes of death, were collected. 2.5 Observation end points Primary outcomes: 28-day and 180-day all-cause mortality rates. Secondary outcomes: Acute neurological complications, including hypoxic-ischemic encephalopathy, intracranial hemorrhage, and ischemic stroke, bleeding events requiring surgical intervention, and ECMO-related complications. 2.6 Statistical methods Continuous variables are reported as mean ± standard deviation, and categorical variables as counts (%). For two-group comparisons, normally distributed continuous variables were analyzed using Student’s t-test, non-normally distributed variables with the Wilcoxon rank-sum test, and categorical variables with the χ² test or Fisher’s exact test. Normality of continuous variables was assessed using the Shapiro‒Wilk test. For three-group comparisons of continuous variables, post-hoc pairwise tests were conducted using ANOVA or the Kruskal-Wallis test based on data distribution. A Kaplan‒Meier curve was used for 28-day survival rate comparisons between two groups. Multivariate logistic regression analysis was applied to compare survival rates at discharge, including all significant univariate variables and clinically relevant factors. Linear regression was used to analyze the correlation between pulmonary artery obstruction scores and patient severity scores, with P < 0.05 indicating statistical significance. All analyses were performed using SPSS 22.0. 3. Results 3.1 Characteristics and Clinical Outcomes of Patients with Suspected Fatal High-Risk PE Between January 2013 and January 2024, a total of 143 patients with suspected fatal high-risk PE were admitted to five ECMO centers. Among these patients, 79 patients received ECMO (ECMO group), whereas 64 underwent pulmonary vascular revascularization therapy (non-ECMO group) (Fig. 2 ). No significant differences were observed between the two groups in baseline characteristics, including gender, age, and VTE risk factors ( P > 0.05) (Table 1 ), or in pretreatment hemodynamic parameters, myocardial injury markers, and APACHE II scores ( P > 0.05) (Table 2 ). The 28-Day mortality rate was lower in the ECMO group than in the non-ECMO group (49.4% vs 71.9%, P < 0.05), and the survival curve was markedly higher ( P 0.05) (Table 3 ). Table 1 Baseline Characteristics of Suspected Patients in the ECMO and non-ECMO Groups Characteristics ECMO Group (N = 79) non-ECMO Group (N = 64) P General Characteristics Age, (yrs) 50.1 ± 13.8 52.0 ± 14.6 0.79 Male, n (%) 18 (45.0%) 13 (56.5%) 0.53 BMI, (kg/m²) 26.8 ± 3.9 24.1 ± 3.1 0.42 Previous medical history Hypertension, n (%) 9 (22.5%) 8 (34.8%) 0.37 Diabetes, n (%) 3 (7.5%) 1 (4.35%) 1.00 Cerebrovascular Disease, n (%) 3 (7.5%) 0 (0%) 0.29 Varicose veins, n (%) 1 (2.5%) 1 (4.35%) 1.00 Risk factors of VTE Tumors, n (%) 5 (12.5%) 2 (8.70%) 1.00 Recent Trauma or Surgery, n (%) 6 (15.0%) 4 (17.4%) 1.00 Duration of Bed Rest > 3 Days, n (%) 15 (37.5%) 9 (39.1%) 1.00 Travel duration > 12 hours, n (%) 4 (10.0%) 2 (8.7%) 1.00 Previous history of VTE, n (%) 4 (10.0%) 4 (17.4%) 0.44 Initial Symptoms of PE Chest Pain, n (%) 3 (7.50%) 2 (8.70%) 0.06 Dyspnea, n (%) 21 (52.5%) 18 (78.3%) Syncope, n (%) 16 (40.0%) 3 (13.0%) APACHE II Score on ICU Admission 30.8 ± 8.8 27.0 ± 7.3 0.07 ECMO: Extracorporeal Membrane Oxygenation; BMI: Body Mass Index; APACHE II: Acute Physiology and Chronic Health Evaluation II;PE: Pulmonary Embolism; VTE: Venous Thromboembolism; ICU: Intensive Care Unit Table 2 Comparison of Pre-ECMO and Pre-Revascularization Characteristics Between ECMO and non-ECMO Groups Characteristics ECMO Group (N = 79) non-ECMO Group (N = 64) P Hemodynamic Parameters VIS 85.5 ± 25.9 82.9 ± 33.1 0.93 HR (bpm) 118 ± 28.7 112 ± 26.1 0.92 MAP (mmHg) 52.3 ± 5.2 57.4 ± 11.4 0.05 Arterial Blood Gas Parameters PH 6.95 ± 0.15 7.05 ± 0.13 0.07 PCO 2 (mmHg) 66.8 ± 7.6 61.1 ± 7.4 0.72 PaO 2 /FIO 2 (mmHg) 66.2 ± 14.5 63.4 ± 11.0 0.39 HCO 3 - (mmol/L) 14.9 ± 2.1 16.5 ± 1.6 0.21 Lac (mmol/L) 11.2 ± 5.27 8.67 ± 6.84 0.13 TTE Parameters RV/LV Ratio 1.2 ± 0.22 1.0 ± 0.21 0.05 Tricuspid Regurgitation Area (cm 2 ) 4.5 ± 1.6 5.6 ± 2.9 0.10 LVEF (%) 50.5 ± 10.7 51.6 ± 12.1 0.72 Blood Biochemistry Parameters TNT I (ng/L) 466 ± 886 225 ± 161 0.10 CK-MB (U/L) 95.1 ± 70.3 70.0 ± 68.8 0.17 D-dimer (pg/ml) 41.4 ± 39.5 37.4 ± 27.3 0.64 APACHEII Score* 32.1 ± 7.5 28.4 ± 6.7 0.07 ECMO: Extracorporeal Membrane Oxygenation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate; TTE: Transthoracic Echocardiography RV/LV: Right Ventricular Diameter/Left Ventricular Diameter; LVEF: Left Ventricular Ejection Fraction; TNT I: Troponin I; CK-MB: Creatine Kinase-MB; *: In the ECMO group prior to cannulation, and in the non-ECMO group before pulmonary vascular recanalization therapy. Table 3 Comparison of Clinical Outcomes Between ECMO and non-ECMO Groups Characteristics ECMO Group (N = 79) non-ECMO Group (N = 64) P Primary Outcome Survival to Discharge, n (%) 40 (50.6%) 19 (29.6%) 0.02 Secondary Outcome Major Bleeding, n (%) 3 (3.7%) 4 (6.2%) 0.25 Neurological Complications, n (%) 5 (6.3%) 1 (1.5%) 0.40 CRRT, n (%) 13 (16.4%) 4 (6.2%) 0.25 CRRT: Continuous Renal Replacement Therapy; ECMO: Extracorporeal Membrane Oxygenation 3.2 Clinical Outcomes of Pulmonary Vascular Revascularization Therapy in Patients with Fatal High-risk PE Under ECMO Among the 63 ECMO patients diagnosed with high-risk PE by CTPA, 37 (58.7%) were successfully weaned from ECMO and 34 (54.0%) were discharged. All underwent pulmonary vascular revascularization under ECMO. Notably, the ECMO + surgical thrombectomy group demonstrated the most favorable prognosis (Fig. 2 ). The baseline characteristics of the three groups (ECMO alone, ECMO + thrombolysis, ECMO + surgical thrombectomy) did not differ significantly ( P > 0.05) (Table 4). Among Table 4 Comparison of Baseline Characteristics Among Three Pulmonary Vascular Revascularization Groups Under ECMO Characteristics ECMO alone (N=40) ECMO+ thrombolysis (N=12) ECMO+ surgical thrombectomy (N=11) P General Characteristics Age, (yrs) 50.1±13.8 54.2±13.4 47.6±15.7 0.52 Male, n (%) 18 (45.0%) 7 (58.3%) 6 (54.5%) 0.71 BMI, (kg/m²) 24.8±3.9 24.9±3.4 23.3±2.5 0.45 Previous medical history Hypertension, n (%) 9 (22.5%) 4 (33.3%) 4 (36.4%) 0.54 Diabetes, n (%) 3 (7.5%) 0 (0%) 1 (9.1%) 0.80 Cerebrovascular Disease, n (%) 3 (7.5%) 0 (0%) 0 (0%) 1.00 Varicose veins, n (%) 1 (2.5%) 1 (8.3%) 0 (0%) 0.60 Risk factors of VTE Tumors, n (%) 5 (12.5%) 1 (8.3%) 1 (9.1%) 1.00 Recent Trauma or Surgery, n (%) 6 (15.0%) 1 (8.3%) 3 (27.3%) 0.47 Duration of Bed Rest >3 Days, n (%) 15 (37.5%) 4 (33.3%) 5 (45.5%) 0.87 Travel duration >12 Hours, n (%) 4 (10.0%) 1 (8.3%) 1 (9.1%) 1.00 Previous history of VTE, n (%) 4 (10.0%) 3 (25.0%) 1 (9.1%) 0.42 Initial Symptoms of PE Chest Pain, n (%) 21 (52.5%) 9 (75.0%) 9 (81.8%) 0.11 Dyspnea, n (%) 16 (40.0%) 1 (8.3%) 2 (18.2%) Syncope, n (%) 3 (7.5%) 2 (16.7%) 0 (0%) APACHE II on ICU Admission 30.8±8.8 26.0±8.3 23.8±6.3 0.03 BMI: Body Mass Index; APACHE II: Acute Physiology and Chronic Health Evaluation II；PE: Pulmonary Embolism; VTE: Venous Thromboembolism; ECMO: Extracorporeal Membrane Oxygenation; ICU: Intensive Care Unit Pre-ECMO data showed the ECMO alone group had the lowest MAP (52.3 ± 5.2 vs 59.8 ± 11.8 vs 54.8 ± 10.9 mmHg, P < 0.05) and pH (7.0 ± 0.2 vs 7.0 ± 0.1 vs 7.1 ± 0.1, P < 0.05), as well as the highest incidence of cardiac arrest (87.5% vs 33.3% vs 72.7%, P 0.05) (Table 5 ). Table 5 Comparison of Pre-ECMO Characteristics Among Three Pulmonary Vascular Revascularization Groups Under ECMO Characteristics ECMO alone (N = 40) ECMO + thrombolysis (N = 12) ECMO + surgical thrombectomy (N = 11) P Indications for ECMO Refractory shock, n (%) 25 (62.5%) 4 (33.3%) 4 (36.4%) 1.00 ECRP, n (%) 15 (37.5%) 8 (66.7%) 7 (63.6%) Hemodynamic Parameters VIS 83.5 ± 25.9 78.0 ± 26.9 88.2 ± 39.4 0.70 HR (bpm) 112.9 ± 28.7 105.3 ± 23.1 119.8 ± 28.1 0.46 MAP (mmHg) 52.3 ± 5.2 59.8 ± 11.8 54.8 ± 10.9 0.02 Arterial Blood Gas Parameters PH 7.0 ± 0.2 7.0 ± 0.1 7.1 ± 0.1 0.01 PaO 2 /FiO 2 (mmHg) 66.2 ± 14.5 62.2 ± 10.3 64.7 ± 12.1 0.66 PCO 2 (mmHg) 61.8 ± 7.6 62.9 ± 7.4 59.1 ± 7.3 0.45 HCO 3 - (mmol/L) 15.9 ± 2.1 16.0 ± 1.8 17.0 ± 1.1 0.24 Lac (mmol/L) 11.2 ± 5.3 9.3 ± 7.1 8.0 ± 6.9 0.24 TTE Parameters RV/LV Ratio 1.1 ± 0.2 1.3 ± 0.3 1.2 ± 0.1 0.12 Tricuspid Regurgitation Area (cm 2 ) 4.5 ± 1.6 6.3 ± 3.6 4.8 ± 1.7 0.04 LVEF (%) 0.5 ± 0.1 0.5 ± 0.1 0.5 ± 0.1 0.74 Blood Biochemistry Parameters TNT I (ng/l) 466.4 ± 885.6 295.9 ± 187.1 148.7 ± 76.3 0.40 CK-MB (u/l) 95.1 ± 70.3 79.4 ± 90.9 59.7 ± 33.2 0.32 D-dimer (pg/ml) 41.4 ± 39.5 38.1 ± 26.1 36.7 ± 29.9 0.91 Time from Symptoms to Deterioration (h) 35 ± 59.2 61 ± 73.8 23.7 ± 42.4 0.29 Time from Shock to ECMO (h) 1.8 ± 2.0 1.4 ± 1.0 0.9 ± 0.4 0.35 Cardiac Arrests, n (%) 35 (87.5%) 4 (33.3%) 8 (72.7%) 0.01 APACHEII Score 32.6 ± 4.5 31.2 ± 4.8 31.2 ± 2.6 0.47 ECMO: Extracorporeal Membrane Oxygenation; ECPR: Extracorporeal Cardiopulmonary Resuscitation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate; TTE: Transthoracic Echocardiography; RV/LV: Right Ventricular Diameter / Left Ventricular Diameter; LVEF: Left Ventricular Ejection Fraction; TNT I: Troponin I; CK-MB: Creatine Kinase-MB For prognostic outcomes, the ECMO + surgical thrombectomy group had the lowest 28-Day (52.5% vs 50.0% vs 9.09%, P < 0.05) and 180-Day mortality rates (55.0% vs 50.0% vs 9.09%, P 0.05) (Fig. 4 ). The ECMO + thrombolysis group had the highest incidence of bleeding complication rate (7.50% vs 33.3% vs 0%, P < 0.05), whereas the ECMO alone group had the highest incidence of neurological complication rate (50.0% vs 8.3% vs 18.2%, P < 0.05) (Table 6). Table 6 Comparison of Post-ECMO Characteristics Among Three Pulmonary Vascular Revascularization Groups Under ECMO Characteristics ECMO alone (N=40) ECMO+ thrombolysis (N=12) ECMO+ surgical thrombectomy (N=11) P Hemodynamics 24H post-ECMO ECMO flow (L/min) 2.9±0.6 2.7±0.8 2.8±0.4 0.72 VIS 38.6±47.7 24.6±40.1 36.8±59.6 0.68 HR (bpm) 99.3±22.3 90.9±25.6 93.2±11.2 0.43 MAP (mmHg) 79.4±21.7 85.4±15.3 95.4±43.2 0.19 Lac (mmol/L) 6.9±6.9 5.7±7.1 2.4±0.8 0.12 CTAP Parameters RV/LV ratio 1.6±0.6 1.7±0.5 1.7±0.5 0.83 PA Diameter (mm) 29.9±4.7 34.3±5.0 29.4±4.1 0.05 Qanadli score 19.1±12.0 22.1±11.3 21.9±5.7 0.73 Primary Outcome Successful ECMO Weaning, n (%) 21 (52.5%) 6 (50.0%) 10 (90.9%) 0.21 28-Day all-cause mortality, n (%) 21 (52.5%) 6 (50.0%) 1 (9.1%) 0.03 180-Day all-cause Mortality, n (%) 22 (45.0%) 6 (50.0%) 1(9.1%) 0.02 Survival to Discharge, n (%) 18 (45.0%) 6 (50.0%) 10 (90.9%) 0.02 Secondary Outcome Major Bleeding, n (%) 3 (7.5%) 4 (33.3%) 0 (0.0%) 0.03 CRRT, n (%) 13 (32.5%) 2 (16.7%) 2 (18.2%) 0.51 Nosocomial Infection, n (%) 9 (22.5%) 0 (0.0%) 2 (18.2%) 0.20 Neurological Complications, n (%) 20 (50.0%) 1 (8.3%) 2 (18.2%) 0.01 ECMO Duration (Days) 3.9±3.6 3.4±2.7 4.0±3.2 0.89 ICU Stay (Days) 12.6±14.0 7.7±6.6 20.0±15.8 0.09 Encephalopathy at 6 Months, n (%) 5 (12.5%) 0 (0.0%) 1 (9.1%) 0.71 ECMO: Extracorporeal Membrane Oxygenation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate; CTPA: computed tomography pulmonary angiography; PA: pulmonary artery; RV/LV: Right Ventricular Diameter/Left Ventricular Diameter; CRRT: Continuous Renal Replacement Therapy; ICU: Intensive Care Unit. 3.3 Risk Factors Affecting the Prognosis of Patients with Fatal High-Risk PE under ECMO Baseline data showed that the Death group had significantly higher APACHE II scores upon ICU admission (Table 7 ). Pre-ECMO data further revealed the following differences (P < 0.05): 1). Longer time from shock to ECMO in the Death group. Higher ECPR proportion, VIS, lactate, PCO₂, and APACHE II scores in the Death group. Lower MAP, LVEF, arterial pH, and HCO₃⁻ levels in the Death group (Table 8 ). Table 7 Comparison of Baseline Characteristics Between Discharge Survivors and In-Hospital Deaths Characteristics Survival Group (N = 34) Death Group (N = 29) P General Characteristics Age, (yrs) 49.5 ± 13.8 51.5 ± 14.3 0.57 Male, n (%) 17 (50.0%) 14 (48.3%) 1.00 BMI, (kg/m²) 24.3 ± 3.3 25.0 ± 4.0 0.64 Previous medical history Hypertension, n (%) 9 (26.5%) 8 (27.6%) 1.00 Diabetes, n (%) 2 (5.9%) 2 (6.9%) 1.00 Cerebrovascular Disease, n (%) 1 (2.9%) 2 (6.9%) 0.59 Varicose veins, n (%) 0 (0.0%) 2 (6.9%) 0.21 Risk factors of VTE Tumors, n (%) 4 (11.8%) 3 (10.3%) 1.00 Recent Trauma or Surgery, n (%) 7 (20.6%) 3 (10.3%) 0.32 Duration of Bed Rest > 3 Days, n (%) 13 (38.2%) 11 (37.9%) 1.00 Travel duration > 12 hours, n (%) 3 (8.8%) 3 (10.3%) 1.00 Previous history of VTE, n (%) 4 (11.8%) 4 (13.8%) 1.00 Initial Symptoms of PE Chest Pain, n (%) 3 (8.82%) 2 (6.90%) 0.92 Dyspnea, n (%) 20 (58.8%) 19 (65.5%) Syncope, n (%) 11 (32.4%) 8 (27.6%) APACHE II Score on ICU Admission 26.5 ± 7.9 31.2 ± 9.0 0.01 BMI: Body Mass Index; APACHE II: Acute Physiology and Chronic Health Evaluation II; PE: Pulmonary Embolism; VTE: Venous Thromboembolism; ICU: Intensive Care Unit Table 8 Comparison of Pre-ECMO Characteristics Between Discharge Survivors and In-Hospital Deaths Characteristics Survival Group (N = 34) Death Group (N = 29) P Indications for ECMO Refractory shock, n (%) 26 (76.5%) 14 (48.3%) 0.04 ECRP, n (%) 8 (23.5%) 15 (51.7%) Hemodynamic Parameters VIS 73.6 ± 28.7 94.7 ± 24.0 0.01 HR (bpm) 110.0 ± 30.7 115.8 ± 23.6 0.86 MAP (mmHg) 56.7 ± 9.1 51.2 ± 6.1 0.01 Arterial Blood Gas Parameters PH 7.0 ± 0.1 6.9 ± 0.2 0.01 PaO 2 /FiO 2 (mmHg) 67.7 ± 11.6 62.2 ± 14.7 0.11 PCO 2 (mmHg) 59.5 ± 5.5 63.9 ± 8.8 0.02 HCO 3 - (mmol/L) 17.3 ± 1.1 14.7 ± 1.7 0.01 Lac (mmol/L) 8.6 ± 5.3 12.2 ± 6.2 0.02 TTE Parameters RV/LV Ratio 1.1 ± 0.2 1.2 ± 0.2 0.08 Tricuspid Regurgitation Area (cm 2 ) 5.0 ± 2.6 4.7 ± 1.7 0.62 LVEF (%) 0.5 ± 0.1 0.5 ± 0.1 0.05 Blood Biochemistry Parameters TNT I (ng/L) 265.2 ± 403.6 511.3 ± 957.7 0.01 CK-MB (U/L) 74.9 ± 62.4 99.0 ± 77.6 0.11 D-dimer (pg/ml) 33.2 ± 29.6 47.8 ± 40.1 0.16 Time from Symptoms to Deterioration (h) 47.3 ± 65.0 27.0 ± 52.7 0.37 Time from Shock to ECMO (h) 1.1 ± 1.5 2.0 ± 1.9 0.01 Cardiac Arrests, n (%) 24 (70.6%) 23 (79.3%) 0.62 APACHEII Score 30.2 ± 3.4 34.3 ± 4.3 0.01 ECMO: Extracorporeal Membrane Oxygenation; ECPR: Extracorporeal Cardiopulmonary Resuscitation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate; TTE: Transthoracic Echocardiography; RV/LV: Right Ventricular Diameter/Left Ventricular Diameter; LVEF: Left Ventricular Ejection Fraction; TNT I: Troponin I; CK-MB: Creatine Kinase-MB Data following ECMO revealed the following: 1) At 24 hours post-ECMO, the ECMO flow rate, VIS, and lactate were higher in the Death group ( P < 0.05). 2) Conversely, the MAP, ECMO duration, and the length of ICU stay were lower in the Death group ( P < 0.05) (Table 9 ). 3) Logistic Regression Analysis identified the time from shock to ECMO as an independent risk factor affecting prognosis ( P < 0.05) (Table 10 ). Table 9 Comparison of Pre-ECMO Characteristics Between Discharge Survivors and In-Hospital Deaths Characteristics Survival Group (N = 34) Death Group (N = 29) P Hemodynamics 24h post-ECMO ECMO flow rate (L/min) 2.7 ± 0.6 2.9 ± 0.6 0.10 VIS 21.3 ± 36.0 52.4 ± 55.4 0.01 HR (bpm) 96.6 ± 18.7 96.7 ± 24.7 0.99 MAP (mmHg) 91.7 ± 29.2 73.6 ± 17.6 0.01 Lac (mmol/L) 3.1 ± 2.8 9.2 ± 7.9 0.01 CTAP Parameters RV/LV ration 1.5 ± 0.6 1.8 ± 0.5 0.07 PA diameter (mm) 30.6 ± 3.9 31.2 ± 6.1 0.71 Qanadli score 20.4 ± 8.8 20.2 ± 13.2 0.96 PRV Strategies ECMO alone 18 (52.9%) 22 (75.9%) 0.02 ECMO + thrombolysis 6 (17.6%) 6 (20.7%) ECMO + surgical thrombectomy 10 (29.4%) 1 (3.45%) Severe ICU Complications Neurological Complications, n (%) 7 (20.6%) 16 (55.2%) 0.01 Major Bleeding, n (%) 3 (8.8%) 4 (13.8%) 0.69 CRRT, n (%) 11 (32.4%) 6 (20.7%) 0.45 Nosocomial Infection, n (%) 7 (20.6%) 4 (13.8%) 0.53 ECMO Duration (Days) 4.7 ± 3.7 2.7 ± 2.7 0.01 ICU Stay (Days) 19.4 ± 14.9 5.5 ± 6.6 0.01 ECMO: Extracorporeal Membrane Oxygenation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate; CTPA: computed tomography pulmonary angiography; PA: Pulmonary Artery; PVR: Pulmonary Vascular Revascularization; RV/LV: Right Ventricular Diameter/Left Ventricular Diameter; CRRT: Continuous Renal Replacement Therapy; ICU: Intensive Care Unit Table 10 Logistic Regression Analysis of Predictors of In-Hospital Mortality for Confirmed Patients Variable OR (95%CI) P ECPR 0.28 (0.02–4.55) 0.37 VIS before ECMO 1.02 (0.99–1.06) 0.06 MAP before ECMO (mmHg) 0.94 (0.81–1.10) 0.48 Lactate (mmol/L) 1.01 (0.88–1.15) 0.87 Time from Shock to ECMO (hour) 1.59 (1.01–2.50) 0.04 APACHEII Score before ECMO 1.35 (1.08–1.69) 0.06 ECPR: Extracorporeal Cardiopulmonary Resuscitation; VIS: Vasoactive-Inotropic Score; ECMO: Extracorporeal Membrane Oxygenation; MAP: Mean Arterial Pressure; APACHE II: Acute Physiology and Chronic Health Evaluation II 3.4 Correlation Between the Severity of Thrombotic Obstruction in The Pulmonary Artery and the Condition of Patients with Fatal High-Risk PE A linear regression analysis examined the relationship between the Qanadli score and the APACHE II score before ECMO in high-risk PE patients. The results indicated no significant linear correlation between these two variables ( P > 0.05) (Fig. 5 ). 4. Discussion Previous studies have demonstrated that the size of thrombus, the location and extent of obstruction are associated with the clinical condition of patients with PE [ 12 , 13 ] and the risk of complications [ 3 , 4 ]. However, in this study, we observed no significant correlation between the Qanadli score and the APACHE II score at the initiation of ECMO in patients with fatal high-risk PE. These findings suggest that the degree of pulmonary artery blockage may not directly correlate with disease severity in these patients. Pulmonary hypertension induced by high-risk PE is attributable not only to mechanical obstruction caused by thrombi but also to functional factors such as hypoxemia, CO 2 retention, and acidosis [ 14 , 15 ]. Furthermore, acute right heart failure in high-risk PE patients is influenced by multiple factors, including pulmonary hypertension, baseline right ventricular function, and volume status [ 3 , 16 ]. Mechanical obstruction represents only one of several contributing risk factors. Therefore, for patients with fatal high-risk PE, it is essential to implement all necessary interventions to optimize their chances of survival. ECMO offers robust cardiopulmonary support, stabilizing respiratory and circulatory functions while enabling the diagnosis and treatment of underlying diseases [ 17 , 18 , 19 ]. Among 79 patients with suspected fatal high-risk PE who underwent CTPA under ECMO, 63 had confirmed high-risk PE, with lower 28-day mortality in the ECMO group than the non-ECMO group, indicating that ECMO not only stabilizes circulation but also mitigates functional contributors to pulmonary hypertension. This facilitates precise therapeutic interventions following accurate diagnosis, thereby improving survival outcomes. Effective pulmonary vascular revascularization in high-risk PE patients on ECMO remains challenging. Experts recommend various strategies: thrombolysis [ 20 ], anticoagulation [ 21 ], and surgery [ 8 ]. However, the optimal revascularization strategy under ECMO is unclear. For patients with high-risk PE on ECMO, successful ECMO weaning is associated with improvements in pulmonary hypertension-related functional impairments, mechanical obstruction, and acute right heart failure. As a key short-term outcome indicator, successful ECMO weaning is crucial for evaluating treatment efficacy. In this study, no significant differences were found among groups, indicating all three methods are viable treatment options under ECMO. For patients who develop complications such as hemodynamic instability and multiple organ failure following ECMO, heparin-based anticoagulation therapy is commonly used. The ECMO alone group had the most cases and the poorest prognosis. Five patients remained reliant on ECMO after one week, subsequently developed nosocomial infections, and ultimately succumbed to multiple organ failure. Based on these findings, our clinical experiences suggest that if patients cannot wean from ECMO within 3–5 days of heparin therapy, alternative revascularization strategies should be considered. Currently, thrombolytic therapy is recognized as the first-line treatment for high-risk PE [ 22 , 23 ]. However, clinicians remain cautious due to the potential risk of fatal bleeding [ 23 , 24 ]. In this study, among 12 patients who were treated with rt-PA, 3 exhibited minor bleeding at the ECMO cannulation site, 1 experienced fatal bleeding at the neck incision, and 1 developed fatal vaginal bleeding associated with increased menstruation. Although no fatal bleeding occurred at the ECMO cannulation site, a thorough bleeding risk assessment is essential prior to initiating thrombolytic therapy [ 20 , 22 , 24 ]. The ECMO + surgical thrombectomy group demonstrated the lowest mortality rate and superior long-term prognosis, findings that are consistent with those of previous studies [ 8 , 25 ]. This may be attributed to better preoperative patient conditions, and effective postoperative resolution of mechanical obstruction. Whether surgical treatment should be considered the preferred revascularization method requires further study. This study shows that fatal high-risk PE patients have prolonged time from shock onset to ECMO, high VIS before ECMO, and high pre-ECMO cardiac arrest rates. Most deaths result from multiple organ failure, which is consistent with prior studies [ 19 ]. Early ECMO support in refractory cardiogenic shock significantly decreases cardiac arrest incidence and improves prognosis [ 26 , 27 , 28 ]. For patients with suspected high-risk PE and circulatory instability, early ECMO support can reduce cardiac arrest or ECPR occurrence and may play a critical role in improving patient outcomes. 5. Limitations 1) Although this study is a retrospective cohort study, as the largest multicenter study involving ECMO in patients with suspected high-risk PE, its results still have significant clinical guiding significance. 2) The non-ECMO group excluded patients without pulmonary vascular revascularization or surgical revascularization, potentially introducing selection bias. 3) The limited use of Swan-Ganz catheter before revascularization made precise evaluation of the three strategies challenging. Although ECMO weaning success rates have limitations, they remain a reliable metric. 6. Conclusion In summary, for patients with suspected high-risk PE who are ineligible for CTPA, prioritizing ECMO support for diagnosis and treatment of the underlying disease may effectively reduce mortality rates. All three revascularization strategies appear to be effective. However, surgical thrombectomy may be considered for eligible patients. The time from shock to ECMO seems to be an important factor affecting prognosis in confirmed cases. Given the retrospective nature of this study, further prospective investigations are essential to validate the findings and establish causality. Declarations Acknowledgements: We would like to express our sincere gratitude to Dr. Peng Wenjuan and Dr. Liu Ye for their invaluable assistance in patient data collection. We are also grateful to Dr. Cheng Shuyu and Dr. Peng Wen for their meticulous proofreading of the manuscript. Their contributions have been instrumental in the completion of this study. Conflict of Interest : The authors declare no conflicts of interest. Financial Interests : This study was supported by the National Natural Science Foundation of China (Grant No. 82470067). The authors have no other financial relationships with any organizations that might have an interest in the submitted work. Author Contributions : Author Name Liu-sheng Hou, Chang-zhi Liu, Zhan-guo Liu, Lihan-Shen, Chun-lai Fu, Yu-xin Liang, Rui-qi Wu: Responsible for study design, data analysis, and manuscript writing. Author Name Xiao-zu Liao, Zhou Chen, Wei-zhao Huang, Zhan-yuan Zhao, Ting Yang: Responsible for data collection and statistical analysis. Author Name Hong-kai Liang, Bing-fei Li: Responsible for study supervision and final manuscript review. All authors have made significant contributions to the manuscript and agree with the final submitted version. Ethical Approval: This study was approved by the Ethics Committee on Clinical Scientific Research and Laboratory Animal of Zhongshan Peoples’s Hospital (approval no. 2025-031). Given the retrospective nature of the study and the use of de-identified patient data, the requirement for informed consent was waived by the IRB. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki and its later amendments. Data Availability : The data underpinning this study were obtained from the case systems of five ECMO medical centers located in the Pearl River Delta region. Given the retrospective nature of the study, some data may be incomplete. The data were not publicly accessible due to privacy and ethical considerations. However, de-identified data may be made available upon reasonable request for legitimate medical research purposes, subject to approval. Requests for data access should be directed to the corresponding author, who will liaise with the relevant medical centers to secure necessary permissions. Data usage will require adherence to ethical standards and patient privacy regulations, potentially necessitating a data use agreement. References Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006;113(4):577–582. doi: 10.1161/CIRCULATIONAHA.105.592592 Kürkciyan I, Meron G, Sterz F, et al. 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Front Med (Lausanne). 2023; 10:1146570. doi: 10.3389/fmed.2023.1146570 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6513648","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452531349,"identity":"53b79564-bd7f-405e-96b6-901f88f9a481","order_by":0,"name":"Liusheng Hou","email":"","orcid":"","institution":"Zhongshan City People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Liusheng","middleName":"","lastName":"Hou","suffix":""},{"id":452531350,"identity":"465cfe9f-2ba4-499c-a51f-e990cfbd2cf3","order_by":1,"name":"Chang zhi Liu","email":"","orcid":"","institution":"Shunde Hospital of Southern Medical 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Liang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIiWNgGAWjYBACPmYgwdgAJHgYGA58MLCp52dmPvwAnxY2ZC0HZ1SkJUi2s6UZ4NXCgKSFmefM4QSD8zwKEni1sDM/e/h1h02evM/hhwd425jzjA/zMBgw1NhE43YYm7mx7Jm0YsOzbQYHJNvYis0O8x54wHAsLbcBt1/MpCXbDidu7GcwOGDYxsO47TBfggFjw2E8Wti/QbWwfziQ2CbBuLmZx0ACvxYeM8mPQC3zeXsMDhw4Y5C4gZmwljJpxra0xA08ZwoONlQkGEscBgZyAh6/8PMf3yb5s80mcX5P+ubPfwz+y/H3Hz784EONDU4tIMAMjBKg35GFEvAoBwHGH0BCHp+ho2AUjIJRMLIBAOgTXG/K9lIrAAAAAElFTkSuQmCC","orcid":"","institution":"Zhongshan City People’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hongkai","middleName":"","lastName":"Liang","suffix":""}],"badges":[],"createdAt":"2025-04-23 14:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6513648/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6513648/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82356828,"identity":"fe1172d0-5908-4e51-ae57-a3f8b945eda8","added_by":"auto","created_at":"2025-05-09 11:19:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34237,"visible":true,"origin":"","legend":"\u003cp\u003eManagement algorithm for patients suspected of having high-risk fatal pulmonary embolism (PE). TTE: Trans-thoracic Echocardiography; CTPA: Computed Tomography Pulmonary Angiography; RV: Right Ventricle; ECMO: Extracorporeal Membrane Oxygenation\u003c/p\u003e","description":"","filename":"Figure11.png","url":"https://assets-eu.researchsquare.com/files/rs-6513648/v1/bd7270e0563681eb560dfae4.png"},{"id":82356829,"identity":"4dc88a3d-87b1-4b09-890c-083e5e3a49f4","added_by":"auto","created_at":"2025-05-09 11:19:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":74371,"visible":true,"origin":"","legend":"\u003cp\u003eA flow chart of the treatment strategies applied in the study population, with outcomes and causes of death. PE: Pulmonary Embolism; ECMO: Extracorporeal Membrane Oxygenation; CPH: Chronic Pulmonary Hypertension; HIE: Hypoxic-Ischemic Encephalopathy\u003c/p\u003e","description":"","filename":"Figure21.png","url":"https://assets-eu.researchsquare.com/files/rs-6513648/v1/735dc5e43ace391c29f70c92.png"},{"id":82361459,"identity":"6c0c82d7-8d76-4de4-8bdf-f5a543b4ea01","added_by":"auto","created_at":"2025-05-09 11:51:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":62512,"visible":true,"origin":"","legend":"\u003cp\u003eThe survival curve was significantly higher in the ECMO group than in the non-ECMO group.\u003c/p\u003e","description":"","filename":"Figure31.png","url":"https://assets-eu.researchsquare.com/files/rs-6513648/v1/e7731873385db3efecafa34e.png"},{"id":82359183,"identity":"ae7b5738-4e7f-4c32-a54d-cf0852ecdf01","added_by":"auto","created_at":"2025-05-09 11:27:51","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":83012,"visible":true,"origin":"","legend":"\u003cp\u003eThe survival curves of the three groups (ECMO alone, ECMO+ thrombolysis, ECMO+ surgical thrombectomy) did not differ significantly (\u003cem\u003eP \u003c/em\u003e\u0026gt; 0.05).\u003c/p\u003e","description":"","filename":"Figure41.png","url":"https://assets-eu.researchsquare.com/files/rs-6513648/v1/730681f4d641ed309708bc52.png"},{"id":82359187,"identity":"8c7aedbf-888f-445e-a975-6c8d009c4e35","added_by":"auto","created_at":"2025-05-09 11:27:51","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":82009,"visible":true,"origin":"","legend":"\u003cp\u003eA linear regression analysis was conducted on the Qanadli score and the APACHE II score before ECMO for patients with fatal high-risk PE. The results showed no significant linear correlation between the two variables\u003c/p\u003e","description":"","filename":"Figure51.png","url":"https://assets-eu.researchsquare.com/files/rs-6513648/v1/cf5f71774771a17d36edf56c.png"},{"id":83118949,"identity":"f538e156-bacb-4d52-94d1-113a86a2bfe3","added_by":"auto","created_at":"2025-05-20 08:38:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2640085,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6513648/v1/6eb6deef-8334-4db8-a072-627bec461bce.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy of ECMO in Managing Suspected Fatal High-Risk Pulmonary Embolism and Prognostic Risk Factors in Confirmed Patients: An 11-Year Multicenter Retrospective Cohort Study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eHigh-risk PE is characterized by a low incidence but rapid progression, frequently resulting in obstructive shock, cardiac arrest, and an extremely high mortality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Early identification and timely intervention are crucial for improving patient outcomes. According to guidelines from European societies, pulmonary vascular revascularization should be initiated promptly in suspected high-risk PE patients who are unable to undergo CTPA [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e However, in clinical practice, while some patients benefit from guideline-recommended management, there are the risks of misdiagnosis and inappropriate treatment persist in suspected cases, and selecting the most appropriate pulmonary revascularization strategies remains challenging. For instance, in suspected patients contraindicated for thrombolysis, the lack of a preoperative CTPA scan can increase surgical complexity and may result in missed opportunities for surgical intervention.\u003c/p\u003e \u003cp\u003eECMO provides robust cardiopulmonary support. Case series studies demonstrate that ECMO is an effective circulatory support modality for patients with high-risk PE, with some patients achieving favorable outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, large-scale studies report a treatment success rate ranging from 38\u0026ndash;50% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Improving survival rates in high-risk PE patients remains a focus of ongoing research.\u003c/p\u003e \u003cp\u003eECMO for managing high-risk PE was first implemented in the Pearl River Delta region in China. Our protocol involves initiating ECMO for some suspected, potentially fatal, cases of prior to pulmonary vascular revascularization. CTPA is performed under ECMO to confirm the diagnosis, followed by targeted therapeutic interventions (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To date, no clinical studies have systematically revealed whether this strategy enhances survival rates in patients with suspected cases.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe retrospectively analyzed the clinical data of patients diagnosed with suspected fatal High-risk PE during hospitalization at five high-volume ECMO centers in Guangdong's Pearl River Delta region. Our study focused on addressing the following key questions: 1) Does ECMO improve survival rates in these patients? 2) What is the optimal strategy for pulmonary vascular revascularization under ECMO? 3) What are the risk factors influencing the prognosis of fatal high-risk PE in patients receiving ECMO? and 4) Is there a correlation between the severity of pulmonary artery thrombus obstruction and patient outcomes? The aim of this research is to increase the treatment success rate for patients with suspected fatal high-risk PE.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Case collection and treatment processes\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.1.1 Case collection\u003c/h2\u003e \u003cp\u003ePatients who were diagnosed with suspected fatal high-risk PE at five high-volume ECMO centers in Guangdong's Pearl River Delta region between January 2013 and January 2024 were included in this study. Patients who did not receive ECMO or pulmonary vascular revascularization treatment were excluded from the analysis. Suspected fatal high-risk PE was defined as persistent systolic blood pressure (SBP) below 90 mmHg despite the use of \u0026ge;\u0026thinsp;2 vasoactive drugs, or repeated episodes of cardiac arrest. Patients with suspected high-risk PE were diagnosed in accordance with the European Society of Cardiology guidelines [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn accordance with current China legislation, informed consent was not required for the retrospective analysis of data routinely collected in the medical files. This study was approved by the Ethics Committee on Clinical Scientific Research and Laboratory Animal of Zhongshan Peoples\u0026rsquo;s Hospital (approval no. 2025-031).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2 Treatment Strategies and Grouping\u003c/h2\u003e \u003cp\u003ePatients with suspected fatal high-risk PE were divided into two groups: The ECMO group and the non-ECMO group, based on whether ECMO was initiated first. The strategies are as follows: 1) ECMO group: ECMO was initiated, followed by diagnosis of the underlying condition and selection of a targeted treatment strategies. 2) non-ECMO group: Pulmonary vascular recanalization via intravenous thrombolysis, heparin anticoagulation, or interventional thrombectomy was performed first. High-risk PE patients on ECMO were divided into two groups by discharge outcome: survival group and death group. Based on pulmonary vascular recanalization therapy, they were further grouped into three subgroups: ECMO alone, ECMO\u0026thinsp;+\u0026thinsp;thrombolysis, ECMO\u0026thinsp;+\u0026thinsp;surgical thrombectomy.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.2 ECMO Intervention Timing, Circuit Establishment, and Management Strategies\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Criteria for ECMO Initiation\u003c/h2\u003e \u003cp\u003eFor patients with suspected fatal high-risk PE, emergency VA-ECMO should be initiated under the following conditions: 1) SBP remains\u0026thinsp;\u0026lt;\u0026thinsp;90 mmHg despite \u0026ge;\u0026thinsp;2 vasoactive drugs; 2) Cardiac arrest occurs and spontaneous circulation is not restored after 10 minutes of cardiopulmonary resuscitation (CPR); or 3) Spontaneous circulation is restored but persistent shock and recurrent cardiac arrest occur despite continued high-dose vasoactive support.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Establishment of the ECMO circuit\u003c/h2\u003e \u003cp\u003eThe peripheral VA-ECMO circuit was inserted under anesthesia by an experienced vascular surgeon, utilizing Medtronic and Maquet devices. It was established via percutaneous femoral arteriovenous incision or puncture with 19-21Fr venous drainage and 17-19Fr arterial return cannulas. Bypass grafts were routinely placed in percutaneous cases to prevent distal ischemia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 ECMO management strategy\u003c/h2\u003e \u003cp\u003eCirculatory Support: The ECMO flow rate was set at 2.0\u0026ndash;4.0 L/min, and a MAP\u0026thinsp;\u0026gt;\u0026thinsp;65 mmHg was maintained through preload optimization and vasopressor administration. Respiratory Support: Lung-protective ventilation was implemented to maintain SpO₂\u0026gt; 92% and PaCO₂ 35\u0026ndash;45 mmHg. Anticoagulation Management: Unfractionated heparin was administered to ensure that the ACT 180\u0026ndash;220 s, and the APTT 50\u0026ndash;80 s. Criteria for ECMO Weaning: 1) Resolution or mitigation of the mechanical or functional causes of pulmonary hypertension. 2) Hemodynamic stability and reduced right atrial/ventricular dimensions and tricuspid regurgitation on transthoracic echocardiograph. 3) Hemodynamic stability after ECMO flow rate is gradually decreased to 0.5 L/min over the course of 1\u0026ndash;2 hours.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Assessment of Pulmonary Vascular Obstruction Severity and Revascularization therapy\u003c/h2\u003e \u003cp\u003eEvaluation of Pulmonary Vascular Obstruction Severity: The severity of pulmonary artery thrombus obstruction was quantified using the Qanadli scoring system [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], based on the findings from CTPA. Higher scores indicate more severe obstruction, with a maximum score of 40. Principles of Pulmonary Vascular revascularization Treatment: 1) Surgical intervention: For patients who were suitable for surgery, perform surgical thrombectomy under cardiopulmonary bypass. 2) Pharmacological therapy: For patients unsuitable for surgery, anticoagulation therapy or thrombolysis was performed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data collection\u003c/h2\u003e \u003cp\u003eParticipants were followed up post-discharge via telephone at two predefined time points: 3 months and 6 months. The baseline characteristics of patients, including sex, age, BMI, comorbidities, and risk factors for deep vein thrombosis (DVT), were recorded. For the ECMO group, pre-ECMO data, including APACHE II scores, vasoactive inotropic scores (VIS), hemodynamic parameters, transthoracic echocardiography findings, and arterial blood gas measurements, were obtained. For the non-ECMO group, clinical data was collected prior to pulmonary vascular revascularization therapy. For high-risk PE patients receiving ECMO, clinical information, including APACHE II scores, VIS, hemodynamic parameters, reperfusion strategies employed, 28-day all-cause mortality rates, and causes of death, were collected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Observation end points\u003c/h2\u003e \u003cp\u003ePrimary outcomes: 28-day and 180-day all-cause mortality rates. Secondary outcomes: Acute neurological complications, including hypoxic-ischemic encephalopathy, intracranial hemorrhage, and ischemic stroke, bleeding events requiring surgical intervention, and ECMO-related complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical methods\u003c/h2\u003e \u003cp\u003eContinuous variables are reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and categorical variables as counts (%). For two-group comparisons, normally distributed continuous variables were analyzed using Student\u0026rsquo;s t-test, non-normally distributed variables with the Wilcoxon rank-sum test, and categorical variables with the χ\u0026sup2; test or Fisher\u0026rsquo;s exact test. Normality of continuous variables was assessed using the Shapiro‒Wilk test. For three-group comparisons of continuous variables, post-hoc pairwise tests were conducted using ANOVA or the Kruskal-Wallis test based on data distribution. A Kaplan‒Meier curve was used for 28-day survival rate comparisons between two groups. Multivariate logistic regression analysis was applied to compare survival rates at discharge, including all significant univariate variables and clinically relevant factors. Linear regression was used to analyze the correlation between pulmonary artery obstruction scores and patient severity scores, with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating statistical significance. All analyses were performed using SPSS 22.0.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Characteristics and Clinical Outcomes of Patients with Suspected Fatal High-Risk PE\u003c/h2\u003e \u003cp\u003eBetween January 2013 and January 2024, a total of 143 patients with suspected fatal high-risk PE were admitted to five ECMO centers. Among these patients, 79 patients received ECMO (ECMO group), whereas 64 underwent pulmonary vascular revascularization therapy (non-ECMO group) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). No significant differences were observed between the two groups in baseline characteristics, including gender, age, and VTE risk factors (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), or in pretreatment hemodynamic parameters, myocardial injury markers, and APACHE II scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The 28-Day mortality rate was lower in the ECMO group than in the non-ECMO group (49.4% \u003cem\u003evs\u003c/em\u003e 71.9%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the survival curve was markedly higher (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Secondary outcomes, such as the incidence of neurological complications and severe bleeding, did not differ significantly between the groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of Suspected Patients in the ECMO and non-ECMO Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECMO Group (N\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enon-ECMO Group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious medical history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (4.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular Disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaricose veins, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (4.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk factors of VTE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumors, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (8.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecent Trauma or Surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Bed Rest\u0026thinsp;\u0026gt;\u0026thinsp;3 Days, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTravel duration\u0026thinsp;\u0026gt;\u0026thinsp;12 hours, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious history of VTE, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitial Symptoms of PE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest Pain, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (7.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (8.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (78.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSyncope, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (13.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPACHE II Score on ICU Admission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eECMO: Extracorporeal Membrane Oxygenation; BMI: Body Mass Index; APACHE II: Acute Physiology and Chronic Health Evaluation II;PE: Pulmonary Embolism; VTE: Venous Thromboembolism; ICU: Intensive Care Unit\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Pre-ECMO and Pre-Revascularization Characteristics Between ECMO and non-ECMO Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECMO Group (N\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enon-ECMO Group (N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemodynamic Parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.5\u0026thinsp;\u0026plusmn;\u0026thinsp;25.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.9\u0026thinsp;\u0026plusmn;\u0026thinsp;33.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR (bpm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118\u0026thinsp;\u0026plusmn;\u0026thinsp;28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112\u0026thinsp;\u0026plusmn;\u0026thinsp;26.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArterial Blood Gas Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaO\u003csub\u003e2\u003c/sub\u003e/FIO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCO\u003csub\u003e3\u003c/sub\u003e\u003cb\u003e-\u003c/b\u003e (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLac (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTTE Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRV/LV Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTricuspid Regurgitation Area (cm\u003cb\u003e2\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlood Biochemistry Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNT I (ng/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e466\u0026thinsp;\u0026plusmn;\u0026thinsp;886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225\u0026thinsp;\u0026plusmn;\u0026thinsp;161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCK-MB (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.1\u0026thinsp;\u0026plusmn;\u0026thinsp;70.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.0\u0026thinsp;\u0026plusmn;\u0026thinsp;68.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer (pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.4\u0026thinsp;\u0026plusmn;\u0026thinsp;39.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.4\u0026thinsp;\u0026plusmn;\u0026thinsp;27.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPACHEII Score*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eECMO: Extracorporeal Membrane Oxygenation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate; TTE: Transthoracic Echocardiography RV/LV: Right Ventricular Diameter/Left Ventricular Diameter; LVEF: Left Ventricular Ejection Fraction; TNT I: Troponin I; CK-MB: Creatine Kinase-MB; *: In the ECMO group prior to cannulation, and in the non-ECMO group before pulmonary vascular recanalization therapy.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Clinical Outcomes Between ECMO and non-ECMO Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECMO Group (N\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enon-ECMO Group (N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Outcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvival to Discharge, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (50.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSecondary Outcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor Bleeding, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological Complications, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRRT, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eCRRT: Continuous Renal Replacement Therapy; ECMO: Extracorporeal Membrane Oxygenation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Clinical Outcomes of Pulmonary Vascular Revascularization Therapy in Patients with Fatal High-risk PE Under ECMO\u003c/h2\u003e \u003cp\u003eAmong the 63 ECMO patients diagnosed with high-risk PE by CTPA, 37 (58.7%) were successfully weaned from ECMO and 34 (54.0%) were discharged. All underwent pulmonary vascular revascularization under ECMO. Notably, the ECMO\u0026thinsp;+\u0026thinsp;surgical thrombectomy group demonstrated the most favorable prognosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The baseline characteristics of the three groups (ECMO alone, ECMO\u0026thinsp;+\u0026thinsp;thrombolysis, ECMO\u0026thinsp;+\u0026thinsp;surgical thrombectomy) did not differ significantly (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;4). Among\u003c/p\u003e \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"124%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4 Comparison of Baseline Characteristics Among Three Pulmonary Vascular Revascularization Groups\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eUnder ECMO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eECMO alone (N=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eECMO+ thrombolysis (N=12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eECMO+ surgical thrombectomy (N=11)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeneral Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eAge, (yrs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e50.1\u0026plusmn;13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e54.2\u0026plusmn;13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e47.6\u0026plusmn;15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.52\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eMale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e18 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e7 (58.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e6 (54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.71\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eBMI, (kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e24.8\u0026plusmn;3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e24.9\u0026plusmn;3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e23.3\u0026plusmn;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.45\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious medical history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eHypertension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e9 (22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e4 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4 (36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.54\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eDiabetes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.80\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eCerebrovascular Disease, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eVaricose veins, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors of VTE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eTumors, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eRecent Trauma or Surgery, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e6 (15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e3 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.47\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eDuration of Bed Rest \u0026gt;3 Days, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e15 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e4 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e5 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.87\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eTravel duration \u0026gt;12 Hours, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003ePrevious history of VTE, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e3 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.42\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial Symptoms of PE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eChest Pain, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e21 (52.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e9 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e9 (81.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.11\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eDyspnea, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e16 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e2 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eSyncope, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e2 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPACHE II on ICU Admission \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e30.8\u0026plusmn;8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e26.0\u0026plusmn;8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e23.8\u0026plusmn;6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.03\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI: Body Mass Index; APACHE II: Acute Physiology and Chronic Health Evaluation II；PE: Pulmonary Embolism; VTE: Venous Thromboembolism; ECMO: Extracorporeal Membrane Oxygenation; ICU: Intensive Care Unit\u0026nbsp;\u003c/p\u003e\u003cp\u003ePre-ECMO data showed the ECMO alone group had the lowest MAP (52.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 \u003cem\u003evs\u003c/em\u003e 59.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8 \u003cem\u003evs\u003c/em\u003e 54.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9 mmHg, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and pH (7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 \u003cem\u003evs\u003c/em\u003e 7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1 \u003cem\u003evs\u003c/em\u003e 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as well as the highest incidence of cardiac arrest (87.5% \u003cem\u003evs\u003c/em\u003e 33.3% \u003cem\u003evs\u003c/em\u003e 72.7%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, the APACHE II scores did not differ among the groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Pre-ECMO Characteristics Among Three Pulmonary Vascular Revascularization Groups Under ECMO\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECMO alone (N\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eECMO\u0026thinsp;+\u0026thinsp;thrombolysis (N\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eECMO\u0026thinsp;+\u0026thinsp;surgical thrombectomy (N\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications for ECMO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefractory shock, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECRP, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemodynamic Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.5\u0026thinsp;\u0026plusmn;\u0026thinsp;25.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.0\u0026thinsp;\u0026plusmn;\u0026thinsp;26.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.2\u0026thinsp;\u0026plusmn;\u0026thinsp;39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR (bpm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112.9\u0026thinsp;\u0026plusmn;\u0026thinsp;28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105.3\u0026thinsp;\u0026plusmn;\u0026thinsp;23.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e119.8\u0026thinsp;\u0026plusmn;\u0026thinsp;28.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArterial Blood Gas Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaO\u003csub\u003e2\u003c/sub\u003e/FiO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCO\u003csub\u003e3\u003c/sub\u003e\u003cb\u003e-\u003c/b\u003e(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLac (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTTE Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRV/LV Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTricuspid Regurgitation Area (cm\u003cb\u003e2\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlood Biochemistry Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNT I (ng/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e466.4\u0026thinsp;\u0026plusmn;\u0026thinsp;885.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e295.9\u0026thinsp;\u0026plusmn;\u0026thinsp;187.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148.7\u0026thinsp;\u0026plusmn;\u0026thinsp;76.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCK-MB (u/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.1\u0026thinsp;\u0026plusmn;\u0026thinsp;70.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.4\u0026thinsp;\u0026plusmn;\u0026thinsp;90.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.7\u0026thinsp;\u0026plusmn;\u0026thinsp;33.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer (pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.4\u0026thinsp;\u0026plusmn;\u0026thinsp;39.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.1\u0026thinsp;\u0026plusmn;\u0026thinsp;26.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.7\u0026thinsp;\u0026plusmn;\u0026thinsp;29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime from Symptoms to Deterioration (h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026thinsp;\u0026plusmn;\u0026thinsp;59.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u0026thinsp;\u0026plusmn;\u0026thinsp;73.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.7\u0026thinsp;\u0026plusmn;\u0026thinsp;42.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime from Shock to ECMO (h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCardiac Arrests, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (87.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPACHEII Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eECMO: Extracorporeal Membrane Oxygenation; ECPR: Extracorporeal Cardiopulmonary Resuscitation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate; TTE: Transthoracic Echocardiography; RV/LV: Right Ventricular Diameter / Left Ventricular Diameter; LVEF: Left Ventricular Ejection Fraction; TNT I: Troponin I; CK-MB: Creatine Kinase-MB\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor prognostic outcomes, the ECMO\u0026thinsp;+\u0026thinsp;surgical thrombectomy group had the lowest 28-Day (52.5% \u003cem\u003evs\u003c/em\u003e 50.0% \u003cem\u003evs\u003c/em\u003e 9.09%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and 180-Day mortality rates (55.0% \u003cem\u003evs\u003c/em\u003e 50.0% \u003cem\u003evs\u003c/em\u003e 9.09%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Survival curves did not differ significantly (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The ECMO\u0026thinsp;+\u0026thinsp;thrombolysis group had the highest incidence of bleeding complication rate (7.50% \u003cem\u003evs\u003c/em\u003e 33.3% \u003cem\u003evs\u003c/em\u003e 0%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whereas the ECMO alone group had the highest incidence of neurological complication rate (50.0% \u003cem\u003evs\u003c/em\u003e 8.3% \u003cem\u003evs\u003c/em\u003e 18.2%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;6).\u003c/p\u003e\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"102%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 76.5042%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 6 Comparison of Post-ECMO Characteristics Among Three Pulmonary Vascular Revascularization Groups Under ECMO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eECMO alone (N=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eECMO+ thrombolysis (N=12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eECMO+ surgical thrombectomy (N=11)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemodynamics 24H post-ECMO\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eECMO flow (L/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e2.9\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e2.7\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e2.8\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eVIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e38.6\u0026plusmn;47.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e24.6\u0026plusmn;40.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e36.8\u0026plusmn;59.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eHR (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e99.3\u0026plusmn;22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e90.9\u0026plusmn;25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e93.2\u0026plusmn;11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eMAP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e79.4\u0026plusmn;21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e85.4\u0026plusmn;15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e95.4\u0026plusmn;43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eLac (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e6.9\u0026plusmn;6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e5.7\u0026plusmn;7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e2.4\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCTAP Parameters \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eRV/LV ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e1.6\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e1.7\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e1.7\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003ePA Diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e29.9\u0026plusmn;4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e34.3\u0026plusmn;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e29.4\u0026plusmn;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eQanadli score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e19.1\u0026plusmn;12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e22.1\u0026plusmn;11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e21.9\u0026plusmn;5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary Outcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eSuccessful ECMO Weaning, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e21 (52.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e10 (90.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003e28-Day all-cause mortality, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e21 (52.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e1 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003e180-Day all-cause Mortality, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e22 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e1(9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eSurvival to Discharge, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e18 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e10 (90.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary Outcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eMajor Bleeding, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e3 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e4 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eCRRT, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e13 (32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e2 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e2 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eNosocomial Infection, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e9 (22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e2 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eNeurological Complications, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e20 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e2 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eECMO Duration (Days)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e3.9\u0026plusmn;3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e3.4\u0026plusmn;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e4.0\u0026plusmn;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eICU Stay (Days)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e12.6\u0026plusmn;14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e7.7\u0026plusmn;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e20.0\u0026plusmn;15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24.8805%;\"\u003e\n \u003cp\u003eEncephalopathy at 6 Months, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3737%;\"\u003e\n \u003cp\u003e5 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.2322%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.6271%;\"\u003e\n \u003cp\u003e1 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.322%;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 76.5042%;\"\u003e\n \u003cp\u003eECMO: Extracorporeal Membrane Oxygenation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate;\u0026nbsp;CTPA: computed tomography pulmonary angiography;\u0026nbsp;PA:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003epulmonary artery; RV/LV: Right Ventricular Diameter/Left Ventricular Diameter; CRRT: \u003cstrong\u003eContinuous Renal Replacement Therapy;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eICU:\u0026nbsp;\u003c/strong\u003eIntensive Care Unit.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Risk Factors Affecting the Prognosis of Patients with Fatal High-Risk PE under ECMO\u003c/h2\u003e \u003cp\u003eBaseline data showed that the Death group had significantly higher APACHE II scores upon ICU admission (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Pre-ECMO data further revealed the following differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05): 1). Longer time from shock to ECMO in the Death group. Higher ECPR proportion, VIS, lactate, PCO₂, and APACHE II scores in the Death group. Lower MAP, LVEF, arterial pH, and HCO₃⁻ levels in the Death group (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Baseline Characteristics Between Discharge Survivors and In-Hospital Deaths\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurvival Group (N\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDeath Group (N\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious medical history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (26.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular Disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaricose veins, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk factors of VTE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumors, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecent Trauma or Surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Bed Rest\u0026thinsp;\u0026gt;\u0026thinsp;3 Days, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (37.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTravel duration\u0026thinsp;\u0026gt;\u0026thinsp;12 hours, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious history of VTE, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitial Symptoms of PE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest Pain, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (8.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (58.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (65.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSyncope, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (27.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPACHE II Score on ICU Admission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBMI: Body Mass Index; APACHE II: Acute Physiology and Chronic Health Evaluation II; PE: Pulmonary Embolism; VTE: Venous Thromboembolism; ICU: Intensive Care Unit\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable 8 Comparison of Pre-ECMO Characteristics Between Discharge Survivors and In-Hospital Deaths\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurvival Group (N\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDeath Group (N\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications for ECMO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefractory shock, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (76.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECRP, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (51.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemodynamic Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.6\u0026thinsp;\u0026plusmn;\u0026thinsp;28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.7\u0026thinsp;\u0026plusmn;\u0026thinsp;24.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR (bpm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110.0\u0026thinsp;\u0026plusmn;\u0026thinsp;30.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115.8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArterial Blood Gas Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaO\u003csub\u003e2\u003c/sub\u003e/FiO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCO\u003csub\u003e3\u003c/sub\u003e\u003cb\u003e-\u003c/b\u003e(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLac (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTTE Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRV/LV Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTricuspid Regurgitation Area (cm\u003cb\u003e2\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlood Biochemistry Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNT I (ng/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e265.2\u0026thinsp;\u0026plusmn;\u0026thinsp;403.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e511.3\u0026thinsp;\u0026plusmn;\u0026thinsp;957.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCK-MB (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.9\u0026thinsp;\u0026plusmn;\u0026thinsp;62.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.0\u0026thinsp;\u0026plusmn;\u0026thinsp;77.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-dimer (pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.2\u0026thinsp;\u0026plusmn;\u0026thinsp;29.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.8\u0026thinsp;\u0026plusmn;\u0026thinsp;40.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime from Symptoms to Deterioration (h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.3\u0026thinsp;\u0026plusmn;\u0026thinsp;65.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;52.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime from Shock to ECMO (h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCardiac Arrests, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (70.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (79.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPACHEII Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eECMO: Extracorporeal Membrane Oxygenation; ECPR: Extracorporeal Cardiopulmonary Resuscitation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate; TTE: Transthoracic Echocardiography; RV/LV: Right Ventricular Diameter/Left Ventricular Diameter; LVEF: Left Ventricular Ejection Fraction; TNT I: Troponin I; CK-MB: Creatine Kinase-MB\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData following ECMO revealed the following: 1) At 24 hours post-ECMO, the ECMO flow rate, VIS, and lactate were higher in the Death group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). 2) Conversely, the MAP, ECMO duration, and the length of ICU stay were lower in the Death group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e9\u003c/span\u003e). 3) Logistic Regression Analysis identified the time from shock to ECMO as an independent risk factor affecting prognosis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Pre-ECMO Characteristics Between Discharge Survivors and In-Hospital Deaths\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurvival Group (N\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDeath Group (N\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemodynamics 24h post-ECMO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECMO flow rate (L/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.3\u0026thinsp;\u0026plusmn;\u0026thinsp;36.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.4\u0026thinsp;\u0026plusmn;\u0026thinsp;55.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR (bpm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96.6\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.7\u0026thinsp;\u0026plusmn;\u0026thinsp;24.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.7\u0026thinsp;\u0026plusmn;\u0026thinsp;29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.6\u0026thinsp;\u0026plusmn;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLac (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCTAP Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRV/LV ration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePA diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQanadli score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePRV Strategies\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECMO alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (52.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (75.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECMO\u0026thinsp;+\u0026thinsp;thrombolysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECMO\u0026thinsp;+\u0026thinsp;surgical thrombectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSevere ICU Complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological Complications, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor Bleeding, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRRT, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNosocomial Infection, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eECMO Duration (Days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICU Stay (Days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eECMO: Extracorporeal Membrane Oxygenation; VIS: Vasoactive-Inotropic Score; HR: Heart Rate; MAP: Mean Arterial Pressure; Lac: Lactate; CTPA: computed tomography pulmonary angiography; PA: Pulmonary Artery; PVR: Pulmonary Vascular Revascularization; RV/LV: Right Ventricular Diameter/Left Ventricular Diameter; CRRT: Continuous Renal Replacement Therapy; ICU: Intensive Care Unit\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic Regression Analysis of Predictors of In-Hospital Mortality for Confirmed Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECPR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.28 (0.02\u0026ndash;4.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVIS before ECMO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.99\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAP before ECMO (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.94 (0.81\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactate (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01 (0.88\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime from Shock to ECMO (hour)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.59 (1.01\u0026ndash;2.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPACHEII Score before ECMO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.35 (1.08\u0026ndash;1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eECPR: Extracorporeal Cardiopulmonary Resuscitation; VIS: Vasoactive-Inotropic Score; ECMO: Extracorporeal Membrane Oxygenation; MAP: Mean Arterial Pressure; APACHE II: Acute Physiology and Chronic Health Evaluation II\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.4 Correlation Between the Severity of Thrombotic Obstruction in The Pulmonary Artery and the Condition of Patients with Fatal High-Risk PE\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA linear regression analysis examined the relationship between the Qanadli score and the APACHE II score before ECMO in high-risk PE patients. The results indicated no significant linear correlation between these two variables (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003ePrevious studies have demonstrated that the size of thrombus, the location and extent of obstruction are associated with the clinical condition of patients with PE [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and the risk of complications [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, in this study, we observed no significant correlation between the Qanadli score and the APACHE II score at the initiation of ECMO in patients with fatal high-risk PE. These findings suggest that the degree of pulmonary artery blockage may not directly correlate with disease severity in these patients.\u003c/p\u003e \u003cp\u003ePulmonary hypertension induced by high-risk PE is attributable not only to mechanical obstruction caused by thrombi but also to functional factors such as hypoxemia, CO\u003csub\u003e2\u003c/sub\u003e retention, and acidosis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Furthermore, acute right heart failure in high-risk PE patients is influenced by multiple factors, including pulmonary hypertension, baseline right ventricular function, and volume status [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Mechanical obstruction represents only one of several contributing risk factors. Therefore, for patients with fatal high-risk PE, it is essential to implement all necessary interventions to optimize their chances of survival.\u003c/p\u003e \u003cp\u003eECMO offers robust cardiopulmonary support, stabilizing respiratory and circulatory functions while enabling the diagnosis and treatment of underlying diseases [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Among 79 patients with suspected fatal high-risk PE who underwent CTPA under ECMO, 63 had confirmed high-risk PE, with lower 28-day mortality in the ECMO group than the non-ECMO group, indicating that ECMO not only stabilizes circulation but also mitigates functional contributors to pulmonary hypertension. This facilitates precise therapeutic interventions following accurate diagnosis, thereby improving survival outcomes.\u003c/p\u003e \u003cp\u003eEffective pulmonary vascular revascularization in high-risk PE patients on ECMO remains challenging. Experts recommend various strategies: thrombolysis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], anticoagulation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and surgery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the optimal revascularization strategy under ECMO is unclear. For patients with high-risk PE on ECMO, successful ECMO weaning is associated with improvements in pulmonary hypertension-related functional impairments, mechanical obstruction, and acute right heart failure. As a key short-term outcome indicator, successful ECMO weaning is crucial for evaluating treatment efficacy. In this study, no significant differences were found among groups, indicating all three methods are viable treatment options under ECMO.\u003c/p\u003e \u003cp\u003eFor patients who develop complications such as hemodynamic instability and multiple organ failure following ECMO, heparin-based anticoagulation therapy is commonly used. The ECMO alone group had the most cases and the poorest prognosis. Five patients remained reliant on ECMO after one week, subsequently developed nosocomial infections, and ultimately succumbed to multiple organ failure. Based on these findings, our clinical experiences suggest that if patients cannot wean from ECMO within 3–5 days of heparin therapy, alternative revascularization strategies should be considered.\u003c/p\u003e \u003cp\u003eCurrently, thrombolytic therapy is recognized as the first-line treatment for high-risk PE [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, clinicians remain cautious due to the potential risk of fatal bleeding [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In this study, among 12 patients who were treated with rt-PA, 3 exhibited minor bleeding at the ECMO cannulation site, 1 experienced fatal bleeding at the neck incision, and 1 developed fatal vaginal bleeding associated with increased menstruation. Although no fatal bleeding occurred at the ECMO cannulation site, a thorough bleeding risk assessment is essential prior to initiating thrombolytic therapy [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The ECMO + surgical thrombectomy group demonstrated the lowest mortality rate and superior long-term prognosis, findings that are consistent with those of previous studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This may be attributed to better preoperative patient conditions, and effective postoperative resolution of mechanical obstruction. Whether surgical treatment should be considered the preferred revascularization method requires further study.\u003c/p\u003e \u003cp\u003eThis study shows that fatal high-risk PE patients have prolonged time from shock onset to ECMO, high VIS before ECMO, and high pre-ECMO cardiac arrest rates. Most deaths result from multiple organ failure, which is consistent with prior studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Early ECMO support in refractory cardiogenic shock significantly decreases cardiac arrest incidence and improves prognosis [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. For patients with suspected high-risk PE and circulatory instability, early ECMO support can reduce cardiac arrest or ECPR occurrence and may play a critical role in improving patient outcomes.\u003c/p\u003e "},{"header":"5. Limitations","content":"\u003cp\u003e1) Although this study is a retrospective cohort study, as the largest multicenter study involving ECMO in patients with suspected high-risk PE, its results still have significant clinical guiding significance. 2) The non-ECMO group excluded patients without pulmonary vascular revascularization or surgical revascularization, potentially introducing selection bias. 3) The limited use of Swan-Ganz catheter before revascularization made precise evaluation of the three strategies challenging. Although ECMO weaning success rates have limitations, they remain a reliable metric.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eIn summary, for patients with suspected high-risk PE who are ineligible for CTPA, prioritizing ECMO support for diagnosis and treatment of the underlying disease may effectively reduce mortality rates. All three revascularization strategies appear to be effective. However, surgical thrombectomy may be considered for eligible patients. The time from shock to ECMO seems to be an important factor affecting prognosis in confirmed cases. Given the retrospective nature of this study, further prospective investigations are essential to validate the findings and establish causality.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe would like to express our sincere gratitude to Dr. Peng Wenjuan and Dr. Liu Ye for their invaluable assistance in patient data collection. We are also grateful to Dr. Cheng Shuyu and Dr. Peng Wen for their meticulous proofreading of the manuscript. Their contributions have been instrumental in the completion of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Interests\u003c/strong\u003e: This study was supported by the National Natural Science Foundation of China (Grant No. 82470067). The authors have no other financial relationships with any organizations that might have an interest in the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: Author Name Liu-sheng Hou, Chang-zhi Liu, Zhan-guo Liu, Lihan-Shen, Chun-lai Fu, Yu-xin Liang, Rui-qi Wu: Responsible for study design, data analysis, and manuscript writing. Author Name Xiao-zu Liao, Zhou Chen, Wei-zhao Huang, Zhan-yuan Zhao, Ting Yang: Responsible for data collection and statistical analysis. Author Name Hong-kai Liang, Bing-fei Li: Responsible for study supervision and final manuscript review. All authors have made significant contributions to the manuscript and agree with the final submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Ethics Committee on Clinical Scientific Research and Laboratory Animal of Zhongshan Peoples\u0026rsquo;s Hospital (approval no. 2025-031).\u0026nbsp;Given the retrospective nature of the study and the use of de-identified patient data, the requirement for informed consent was waived by the IRB. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e: The data underpinning this study were obtained from the case systems of five ECMO medical centers located in the Pearl River Delta region. Given the retrospective nature of the study, some data may be incomplete. The data were not publicly accessible due to privacy and ethical considerations. However, de-identified data may be made available upon reasonable request for legitimate medical research purposes, subject to approval. Requests for data access should be directed to the corresponding author, who will liaise with the relevant medical centers to secure necessary permissions. Data usage will require adherence to ethical standards and patient privacy regulations, potentially necessitating a data use agreement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006;113(4):577\u0026ndash;582. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/CIRCULATIONAHA.105.592592\u003c/span\u003e\u003cspan address=\"10.1161/CIRCULATIONAHA.105.592592\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026uuml;rkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. 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Front Med (Lausanne). 2023; 10:1146570. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fmed.2023.1146570\u003c/span\u003e\u003cspan address=\"10.3389/fmed.2023.1146570\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Extracorporeal Membrane Oxygenation, High-Risk Pulmonary Embolism, Pulmonary Vascular Revascularization, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-6513648/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6513648/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eFor patients with suspected fatal high-risk pulmonary embolism (PE) who cannot undergo computed tomography pulmonary angiography (CTPA), should ECMO rescue be prioritized over pulmonary vascular revascularization? What is the optimal revascularization strategy for patients under ECMO? What are the key risk factors affecting prognosis? This study addresses these questions to improve outcomes in high-risk PE.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eClinical data of 143 patients with suspected fatal high-risk PE admitted to five ECMO centers (January 2013-January 2024) were retrospectively analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e1. Of 143 patients, 79 initially received ECMO (ECMO group), whereas 64 received revascularization (non-ECMO group). The baseline characteristics were similar between the two groups. However, the 28-Day mortality rate was lower in the ECMO group (49.4%, 39/79) than in the non-ECMO group (71.9%, 46/64; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). 2. Among 79 ECMO-treated patients, CTPA confirmed PE in 63. Successful ECMO weaning rate was 58.7% (37/63), ECMO duration was 3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 days, and the survival to discharge was 54.0% (34/63). 3. Comparisons among ECMO\u0026thinsp;+\u0026thinsp;surgical thrombectomy, ECMO\u0026thinsp;+\u0026thinsp;thrombolysis, and ECMO alone groups showed the lowest 28-Day mortality with ECMO\u0026thinsp;+\u0026thinsp;surgical thrombectomy (9.1% \u003cem\u003evs\u003c/em\u003e 50.0% \u003cem\u003evs\u003c/em\u003e 52.5%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). 4. Logistic Regression Analysis identified the time from shock to ECMO as an independent risk factor affecting prognosis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFor patients with suspected fatal high-risk PE, treating the primary disease under ECMO reduces mortality. Surgical thrombectomy may be considered for eligible patients. The time from shock to ECMO is an important factor affecting prognosis in confirmed cases.\u003c/p\u003e","manuscriptTitle":"Efficacy of ECMO in Managing Suspected Fatal High-Risk Pulmonary Embolism and Prognostic Risk Factors in Confirmed Patients: An 11-Year Multicenter Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 11:19:47","doi":"10.21203/rs.3.rs-6513648/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bebbc643-26ad-4e95-a802-0afbbd62f34c","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-20T08:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 11:19:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6513648","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6513648","identity":"rs-6513648","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}