Emergency surgical pulmonary embolectomy is a highly effective treatment for selected patients with pulmonary embolism. Rapid noninvasive diagnostic modalities allow proper patient selection based on anatomic location of the emboli, right heart function, and contraindications to thrombolysis. Operative results are a direct reflection of the preoperative hemodynamic status, the degree of underlying cardiopulmonary disease, and attention to minimizing surgical trauma and protecting the right heart. An operative mortality of 10% or less and excellent long-term outcomes can be expected if the procedure is performed prior to cardiovascular collapse as part of a multidisciplinary strategy which emphasizes careful patient selection, rapid diagnosis, triage, and transport.