Pulmonary embolism may cause cardiac arrest secondary to obstruction of blood flow. Traditional treatment strategies include
anticoagulation, thrombolysis, and mechanical extraction. Some advocate for support with extra corporeal membrane oxygenation
(ECMO); however, surgical therapies are contraindicated following thrombolytics. We describe the emergent use of peripheral
ECMO following thrombolytic therapy for a saddle pulmonary embolism associated with multiple episodes of cardiac arrest. The
patient was stabilized with peripheral ECMO, anticoagulated and subsequently weaned from ECMO without any major bleeding
complications. The administration of thrombolytics should not be a contraindication for ECMO in patients with massive pulmonary
embolism associated with hemodynamic instability.