Pulmonary embolism (PE) is a common medical condition associated with significant morbidity and mortality. It is the third most common cause of death in the United States. Historically, surgery for PE was associated with a high mortality rate, and this led to a significant decrease in the volume of operations being performed. However, significant improvements in patient selection and outcomes for surgical pulmonary embolectomy (SPE) at the end of the 20th century led to a renewed interest in the procedure. SPE was historically reserved for patients presenting with acute PE and hemodynamic collapse or cardiac arrest. Contemporary data has provided sufficient evidence to support earlier intervention for patients with acute PE who demonstrate clinical, laboratory, and echocardiographic signs of right ventricular dysfunction. Institutions with cardiac surgery capabilities are implementing SPE earlier for the management of both massive and submassive PEs with excellent short-term and long-term outcomes. Recently, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been employed successfully to treat patients with massive PE. Excellent short-term outcomes have been reported for patients suffering from PE after treatment with VA-ECMO. Further research, specifically with randomized controlled trials, is needed to determine the appropriate timing and patient selection for the use of VA-ECMO in patients with PE. These data would lead to updated guidelines and algorithms incorporating VA-ECMO and SPE for patients with PE.

肺栓塞 (PE) 是一种与显着发病率和死亡率相关的常见疾病。它是美国第三大最常见的死亡原因。从历史上看，PE手术与高死亡率相关，这导致手术量显着减少。然而，在 20 世纪末，手术肺栓塞切除术 (SPE) 患者选择和结果的显着改善导致对该手术重新产生兴趣。SPE 历来仅用于出现急性 PE 和血流动力学衰竭或心脏骤停的患者。当代数据提供了足够的证据支持对临床、实验室和超声心动图显示右心室功能障碍的急性肺栓塞患者进行早期干预。具有心脏手术能力的机构正在更早地实施 SPE，以管理具有出色短期和长期结果的大规模和次大规模 PE。最近，静脉动脉体外膜肺氧合 (VA-ECMO) 已成功用于治疗大量 PE 患者。据报道，在接受 VA-ECMO 治疗后患有 PE 的患者具有良好的短期结果。需要进一步研究，特别是随机对照试验，以确定在 PE 患者中使用 VA-ECMO 的适当时机和患者选择。这些数据将导致更新指南和算法，将 VA-ECMO 和 SPE 纳入 PE 患者。