What is the recommended approach when pulmonary embolism is suspected in a pediatric arrest?

• A. Immediate systemic thrombolysis in all cases
• B. Supportive measures, consider thrombolysis only in selected cases with pediatric specialist guidance; consult pediatric cardiology
• C. Anticoagulation with heparin without guidance
• D. Ignore and continue standard CPR

Answer: (B)

When a pulmonary embolism is suspected in a child who is in arrest, the priority is to support the patient and bring in expert guidance before using powerful clot-busting therapy. The safest and most appropriate approach is to continue resuscitation with supportive measures and involve pediatric specialists. Thrombolysis is not given routinely in children because the bleeding risks are high and the evidence base is limited; it should be considered only in selected cases with guidance from pediatric cardiology (and often hematology or critical care). If a specialist determines thrombolysis may be appropriate, proceed under their direction; otherwise, proceed with ongoing CPR and standard resuscitation plans while addressing the reversible aspects of the situation. Options that push for universal thrombolysis, anticoagulation without input, or ignoring the problem do not fit the nuanced, risk-aware management required in pediatric arrest.