Figure 2).

Massive pulmonary embolism in a 35-year-old woman presenting with cardiac arrest and asystole. The patient was brought in by emergency medical services under continuous resuscitation; transient resumption of electrical activity was followed by clear ST-segment elevations in lead III (upper left panel). The patient was then transferred to the catheter laboratory and connected to veno-arterial extracorporeal membrane oxygenation, where pulmonary embolism diagnosis was confirmed by pulmonary angiography detecting virtually complete pulmonary bed obstruction. Thrombolytic therapy and catheter-based mechanical thrombus fragmentation failed to restore adequate flow through the pulmonary bed. The lower panel clearly shows the macroscopic autopsy finding of the pulmonary bed filled up with fresh thrombi. The right panel displays a myocardial section (documenting massive right ventricular wall effusion) indicating critical right-heart overload and possible mimicking of the above electocardiographic finding. Intraresuscitation selective coronary angiography ruled out coronary artery obstruction. (Images reproduced with permission from archives of the Department of Pathology, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic)