It appears that there is benefit with thrombolysis in ST-elevation myocardial infarction (STEMI) and hemodynamically unstable pulmonary embolism (PE) [1,2]. In cardiac arrest the evidence is inconclusive although there is a robust biological rationale [1,2]. TROICA (Thrombolysis for Out of Hospital Cardiac Arrest), a large double-blinded randomized placebo controlled trial showed no difference in 30-day mortality between thrombolysis and placebo group [3]. However, anti-thrombotics and salicylates weren't given with the fibrinolytic agent in the TROICA trial, and multiple case reports and animal studies in the literature did show benefit in return of spontaneous circulation and neurological outcome in subjects given thrombolysis [4,5].