This study evaluates the use of extracorporeal membrane oxygenation (ECMO) in treating high-risk massive pulmonary embolism (PE) in 27 patients from 2018 to 2023. ECMO was initiated pre-, intra-, or post-operatively in conjunction with surgical embolectomy or catheter-based thrombectomy. ECMO demonstrated significant benefits, including hemodynamic stabilization, reduced right ventricular overload, and improved survival (81.5%). Challenges included Harlequin syndrome and procedural complications. Findings support ECMO as a bridge to recovery, emphasizing the need for optimized patient selection and management strategies.