In high-risk PE with shock and contraindications or failure of CDT, systemic thrombolysis remains the first-line reperfusion therapy. This case demonstrates that low-dose systemic alteplase can be safely administered on venoarterial extracorporeal membrane oxygenation to restore reperfusion and unload the failing right ventricular, leading to resolution of shock.
Nehete et al. (Sun,) studied this question.