Between 1979 and 1988 massive pulmonary embolism (PE) was treated surgically in 36 patients with extracorporeal circulation (ECC). Circulation was stable in 11 patients and unstable in 25; in this group 9 had previous resuscitation because of cardiac arrest. There were 7/36 early deaths (19%); 5 of those patients had to be resuscitated prior to surgery. Deaths were caused mainly by cerebral edema or hemorrhage. Significant complications occurred in 8 patients (28%). Diagnoses of PE was made clinically in most cases; confirmation by echocardiography was useful. Pulmonary angiography was made in patients with uncertain diagnosis and stable circulation. Operation is indicated in patients with unstable circulation and proved central PE; it is advisible in patients with embolism of the main pulmonary artery or its major branches. Hospital mortality is very high when the patient has to be resuscitated preoperatively; in this group surgery should be performed only in younger patients with a short period of resuscitation. Interruption of the inferior vena cava should be performed to prevent recurrent PE.