A Fatal Case of Massive Pulmonary Embolism: A Call to Personalized Cardiac Arrest Management and Equitable Access to Mechanical Circulatory Support

Background: Massive pulmonary embolism (PE) is a well-recognized cause of cardiac arrest and refractory shock. Optimal management requires timely diagnosis, physiologic monitoring, and, in selected cases, mechanical circulatory support (MCS).Case Summary: We present the case of a 45-year-old woman who suffered cardiac arrest from presumed massive pulmonary embolism. She underwent prolonged and complex resuscitation that integrated transesophageal echocardiography (TEE), aortic occlusion catheter placement, and transcranial Doppler (TCD) monitoring. Despite return of spontaneous circulation (ROSC) following aortic balloon inflation, she ultimately succumbed to refractory right-ventricular failure. The case highlights both the physiologic potential of multimodal resuscitation monitoring and the systemic inequities in timely access to extracorporeal support. Discussion: The use of resuscitative TEE, TCD, and near-infrared spectroscopy (NIRS) provides real-time, patient-specific data to individualize resuscitation. These tools may help identify reversible physiology and refine CPR quality. Simultaneously, this case emphasizes the urgent need for equitable MCS access for community hospitals to reduce preventable mortality.