The fulminant pulmonary embolism is one of the most feared complications of hospitalized patients. A high percentage of those patients need resuscitation within a short period of time. In such cases, the thrombolysis is a quickly attained therapeutical alternative to pulmonary embolectomy. A 77-year-old man with a surgically managed femoral fracture who suffered a massive pulmonary embolism, had to be resuscitated on the 11th postoperative day. Because of the fast confirmation of the diagnosis with the ECG and transthoracical echocardiography, it was possible to initiate thrombolysis with a bolus of 100 mg rt-PA immediately after the beginning of cardiac arrest and resuscitation. After 20 min of cardiopulmonary resuscitation (CPR), the patient could be stabilized under high dosage of catecholamines. The patient survived after prolonged intensive care treatment without severe bleeding complications, neither did he present any neurological deficit. We conclude that in the case of massive pulmonary embolism with small chance of resuscitation, the high-dose bolus injection of rt-PA could enrich the therapeutical possibilities.