We describe a case of abrupt cardiac arrest in an 80 year old woman. Emergent transoesophageal echocardiography (TOE) helped clarify the diagnosis of pulmonary embolism, and guide management and ongoing resuscitation. This case highlights the utility of TOE in the peri-arrest setting and in the diagnosis of massive pulmonary embolism. TOE can also be useful in providing prognostic information and determining the choice of therapeutic drug treatment and vasopressor support.