Hippocrates said, "For extreme illness, extreme measures are warranted." Massive pulmonary embolism is an uncommon clinical problem for which extreme measures, such as surgical embolectomy, appear warranted. Since the application of cardiopulmonary bypass to surgical embolectomy in 1961, a number of uncontrolled retrospective case series suggest that nearly one half of patients survive when they undergo emergent embolectomy, in spite of preoperative cardiac arrest. Transvenous catheter embolectomy or catheter disruption of thrombi offers alternatives for hypotensive patients who do not require cardiopulmonary resuscitation. In addition, pulmonary artery stent placement can improve pulmonary artery flow for selected patients who have massive pulmonary embolism.