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

particularly when the condition leading to the arrest was acute pulmonary embolism . . . '. 5 There is also pragmatic reason to analyse fibrinolysis in PE patients 'peri-CPR'. Some clinical characteristics can help to identify PE as the likely cause of cardiac arrest including: respiratory distress and altered mental status before the episode, age under 65, witnessed arrest, and the presence of pulseless electrical activity as the first rhythm. With such PE patients correctly identified, fibrinolytic efficacy might be very high, with survival rate over 50%. 7 In conclusion, PE may cause cardiac arrest, and such patients have been candidates for thrombolysis. This deserves elaboration in PE guidelines, as done in contemporary CPR guidelines, because thrombolysis has been the most important and challenging therapeutic decision in PE.