Effectiveness and major bleeding complications with venoarterial extracorporeal membrane oxygenation in category E pulmonary thromboembolism: a multicentre retrospective study
4 affiliations
- 1Department of Critical Care Medicine, Guang’an People’s Hospital, Guang’an, China
- 2Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 3Key Laboratory of Laboratory Medical Diagnostics of Ministry of Education, Chongqing Medical University, Chongqing, China
- 4Army Medical Center of PLA, Chongqing, China
Abstract
Background Evidence supporting venoarterial extracorporeal membrane oxygenation (VA-ECMO) in Category E pulmonary thromboembolism (PTE) under the 2026 American Heart Association/American College of Cardiology guideline remains limited. We evaluated associations with 30-day mortality and in-hospital major bleeding.Methods This multicentre retrospective cohort included consecutive patients with Category E PTE admitted to four tertiary centres in Southwest China from January 2019 to August 2025. Primary outcomes were 30-day all-cause mortality and in-hospital major bleeding. Mortality was evaluated using Kaplan-Meier analysis and Cox regression. Major bleeding was analysed using Fine-Gray regression with death before bleeding as a competing event.Results Among 95 patients, 39 received VA-ECMO and 56 did not. 30-day mortality was 43.6% and 62.5%, respectively. VA-ECMO was associated with lower mortality in the multivariable model (adjusted HR 0.44, 95% CI 0.22 to 0.88). Major bleeding occurred in 35.9% of VA-ECMO recipients and 16.1% of patients without VA-ECMO (unadjusted subdistribution HR (sHR) 2.50, 95% CI 1.11 to 5.64; p=0.027). The adjusted association was not statistically significant (sHR 1.18, 95% CI 0.44 to 3.12; p=0.743).Conclusions In patients with Category E PTE, VA-ECMO was associated with lower 30-day mortality after adjustment for baseline differences. Although in-hospital major bleeding was more frequent among VA-ECMO recipients in unadjusted analyses, this association was not statistically significant after multivariable adjustment. Cardiac arrest and baseline creatinine and fibrinogen levels were independently associated with major bleeding.
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BibTeX
@article{wang2026effectiveness,
title = {{Effectiveness and major bleeding complications with venoarterial extracorporeal membrane oxygenation in category E pulmonary thromboembolism: a multicentre retrospective study}},
author = {Jian Wang and Xiaohui Wang and Hong Chen and Yi Yan and Qin Hu and Yifan Zhao and Zhuoya Ma and Bingling He and Shengxin Fan and Huaxiao Li},
journal = {BMJ Open Respiratory Research},
year = {2026},
month = nov,
doi = {10.1136/bmjresp-2026-004738},
url = {https://doi.org/10.1136/bmjresp-2026-004738},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effectiveness and major bleeding complications with venoarterial extracorporeal membrane oxygenation in category E pulmonary thromboembolism: a multicentre retrospective study
AU - Jian Wang
AU - Xiaohui Wang
AU - Hong Chen
AU - Yi Yan
AU - Qin Hu
AU - Yifan Zhao
AU - Zhuoya Ma
AU - Bingling He
AU - Shengxin Fan
AU - Huaxiao Li
PY - 2026
DA - 2026/11/08
JO - BMJ Open Respiratory Research
DO - 10.1136/bmjresp-2026-004738
UR - https://doi.org/10.1136/bmjresp-2026-004738
AB - Background Evidence supporting venoarterial extracorporeal membrane oxygenation (VA-ECMO) in Category E pulmonary thromboembolism (PTE) under the 2026 American Heart Association/American College of Cardiology guideline remains limited. We evaluated associations with 30-day mortality and in-hospital major bleeding.Methods This multicentre retrospective cohort included consecutive patients with Category E PTE admitted to four tertiary centres in Southwest China from January 2019 to August 2025. Primary outcomes were 30-day all-cause mortality and in-hospital major bleeding. Mortality was evaluated using Kaplan-Meier analysis and Cox regression. Major bleeding was analysed using Fine-Gray regression with death before bleeding as a competing event.Results Among 95 patients, 39 received VA-ECMO and 56 did not. 30-day mortality was 43.6% and 62.5%, respectively. VA-ECMO was associated with lower mortality in the multivariable model (adjusted HR 0.44, 95% CI 0.22 to 0.88). Major bleeding occurred in 35.9% of VA-ECMO recipients and 16.1% of patients without VA-ECMO (unadjusted subdistribution HR (sHR) 2.50, 95% CI 1.11 to 5.64; p=0.027). The adjusted association was not statistically significant (sHR 1.18, 95% CI 0.44 to 3.12; p=0.743).Conclusions In patients with Category E PTE, VA-ECMO was associated with lower 30-day mortality after adjustment for baseline differences. Although in-hospital major bleeding was more frequent among VA-ECMO recipients in unadjusted analyses, this association was not statistically significant after multivariable adjustment. Cardiac arrest and baseline creatinine and fibrinogen levels were independently associated with major bleeding.
SN - 2052-4439
ER -