Acute pulmonary embolism (PE) is a common and potential lifethreatening condition. Nevertheless the advancements in the patient visitation and treatment algorithms have been few and the mortality unchanged high. Acute high risk PE, which is the most serious subtype, is primary treated with trombolysis. This treatment is not always possible or sufficient. Recent studies have shown that surgical embolectomy is a relevant treatment offer with low mortalities of 6-8%. Patients with acute critical PE should be evaluated and treated in a multidisciplinary centre with medical and surgical possibilities.