Objective To describe the clinical profiles of cardiac arrest due to fatal pulmonary embolism (FPE), and review the literature on FPE diagnosis and treatment. Methods The clinical profiles of two cases with cardiac arrest for FPE were presented. A systematic search of Medline (1950 - 2014) and EMbase (1980-2014) was conducted to identify studies that investigated the use of thrombolytic medications to treat cardiac arrest for FPE. Results The fatal event of two patients occurred after surgery. Both of them survived with cardiopulmonary resuscitation and administration of thrombolysis and anticoagulation, but one of them had major bleeding during anticoagulation. Six articles were found involving 72473 cases of cardiac arrest due to pulmonary embolism (PE) or unstable massive PE. The thrombolytic agents were recombinant tissue plasminogen activator or streptokinase, but the administration and dose of thrombolytic agents were unclear. Overall, administration of thrombolytics can shorten the time to return of spontaneous circulation and improve the survival rate. There was, however, an increased risk of bleeding events following administration of thrombolytics. Conclusions Because of the high mortality of cardiac arrest for FPE, the clinician should correctly identify patients with a high likelihood of FPE. Early use of thrombolytics is very important and can potentially improve patient outcomes.