In pediatric pulmonary embolism arrest, which statement about thrombolysis is correct?

• A. It should be avoided entirely in children.
• B. Thrombolysis should be considered in select cases per protocol.
• C. It should be given in all suspected PE arrests.
• D. Thrombolysis should be performed only after imaging confirmation.

Answer: (B)

In pediatric pulmonary embolism that leads to arrest, thrombolysis is not a routine, one-size-fits-all step. It is a potential lifesaving option when a massive PE is suspected and there is hemodynamic collapse, but it must be considered carefully under a protocol that weighs the benefits of dissolving the clot against the risks of bleeding in a child. The idea is to restore pulmonary perfusion quickly to relieve right heart strain and improve chances of return of spontaneous circulation, especially when imaging may not be feasible during an arrest and time is critical. Because bleeding risk and individual patient factors are important, thrombolysis is not automatically given in every suspected PE arrest, nor is it withheld entirely; it is chosen based on institutional guidelines and the specific clinical scenario.