Mechanical circulatory support may help patients with massive pulmonary embolism who are not candidates for systemic thrombolysis, pulmonary embolectomy, or catheter-directed therapy, or in whom these established interventions have failed. Little published literature covers this topic, which led us to compare outcomes of patients whose massive pulmonary embolism was managed with the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or a right ventricular assist device (RVAD).

We searched the medical literature from January 1990 through September 2018 for reports of adults hospitalized for massive or high-risk pulmonary embolism complicated by hemodynamic instability, and who underwent VA-ECMO therapy or RVAD placement. Primary outcomes included weaning from mechanical circulatory support and discharge from the hospital. We found 16 reports that included 181 patients (164 VA-ECMO and 17 RVAD).

All RVAD recipients were successfully weaned from support, as were 122 (74%) of the VA-ECMO patients. Sixteen (94%) of the RVAD patients were discharged from the hospital, as were 120 (73%) of the VA-ECMO patients. Of note, the 8 RVAD patients who had an Impella RP System were all weaned and discharged.

For patients with massive pulmonary embolism who are not candidates for conventional interventions or whose conditions are refractory, mechanical circulatory support in the form of RVAD placement or ECMO may be considered. Larger comparative studies are needed.

机械循环支持可帮助不适合全身溶栓、肺栓塞切除术或导管定向治疗的大面积肺栓塞患者，或这些既定干预措施已失败的患者。很少有已发表的文献涉及这个主题，这导致我们比较了使用静脉动脉体外膜肺氧合 (VA-ECMO) 或右心室辅助装置 (RVAD) 治疗大面积肺栓塞患者的结果。

我们检索了 1990 年 1 月至 2018 年 9 月的医学文献，以了解因大面积或高危肺栓塞并发血流动力学不稳定而住院并接受 VA-ECMO 治疗或 RVAD 放置的成年人的报告。主要结局包括退出机械循环支持和出院。我们发现了 16 份报告，其中包括 181 名患者（164 名 VA-ECMO 和 17 名 RVAD）。

所有 RVAD 接受者均成功脱离支持，122 名 (74%) VA-ECMO 患者也是如此。16 名 (94%) RVAD 患者出院，120 名 (73%) VA-ECMO 患者出院。值得注意的是，拥有 Impella RP 系统的 8 名 RVAD 患者均已断奶并出院。

对于不适合常规干预或病情难治的大面积肺栓塞患者，可以考虑以 RVAD 放置或 ECMO 形式提供机械循环支持。需要更大规模的比较研究。