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Thrombolysis during cardiopulmonary resuscitation should be addressed in guidelines for pulmonary embolism.

Dr Koracevic raised an interesting point, suggesting that thrombolysis should be recommended in patients with PE who present with cardiac arrest. Indeed, if caused by PE, cardiac arrest is indicating the highest risk of early death. And resuscitation is no longer considered an important contraindication to thrombolytic treatment.1 The problem is in diagnosing PE in the setting of cardiac arrest.

Thrombolytic treatment was suggested to increase the chances of survival in unselected patients with cardiac arrest. However, encouraging preliminary reports and a metaanalysis of eight trials including 926 patients2 were not confirmed by a large multicentre study. In fact, the …