To share the importance and experience venous arterial extracorporeal oxygenation (VA-ECMO) -assisted thrombolysis in the treatment of acute high-risk pulmonary embolism patients.

One patient with acute high-risk pulmonary embolism was confirmed by pulmonary artery CT angiography (CTA). He was continuous break of syncope for half a day without obvious causes and precipitating factor. He with chest tightness, palpitation, sweating, dizziness and other symptoms, was need a large dose of Norepinephrine to maintain low blood pressure and pulse oxygen saturation was decreased. The transchest CT examination showed a significant enlargement of the right heart. Pulmonary CTA examination showed massive emboli in bilateral main and branch pulmonary arteries. Bedside cardiac ultrasound showed reduced LV systolic function, significant enlargement of the right heart and increased pulmonary artery pressure. The diagnosis of acute severe pulmonary embolism was made and bedside ECMO was treated with urokinase thrombolysis.

After ECMO treatment patients vital signs were stable, blood pressure and oxygen saturation condition improved significantly. ECMO was smoothly evacuated after four days and Dalteparin anticoagulant therapy was continued. One week later, pulmonary CTA showed almost complete absorption of the left pulmonary embolus and partial absorption of the right pulmonary plug. Two weeks later, reexamination of pulmonary artery CTA showed almost complete absorption of bilateral pulmonary artery emboli and warfarin anticoagulation was continued for three months after discharge.

ECMO has advantages for reversible pulmonary disease and won enough time to rescue acute high-risk pulmonary embolism. VA-ECMO adjuvant thrombolysis for acute high-risk pulmonary embolism is a safe and effective treatment measure but there is still a controlled study with large samples in the effectiveness evaluation and additional evidence from prospective management studies is needed.