The patient was a 77 years old woman. She was admitted to the emergency room for severe dyspnea. Her vital signs at the hospital arrival were pulse rate of 111 /min, blood pressure of 70/52 mmHg, and percutaneous arterial oxygen saturation 91% on room air. ST depression of right chest leads on electrocardiogram, bilateral massive pulmonary embolism on contrast-enhanced chest CT, and dilated right ventricle compressing the septal wall of the left ventricle on echocardiography were shown, and consequently, she was diagnosed with acute massive pulmonary embolism. Immediately, we started anti-coagulation therapy with heparin administration. The emergency surgical embolectomy was indicated to perform simultaneously. Since there was a possibility of hemodynamic deterioration, we decided to initiate percutaneous cardiopulmonary support (PCPS) to avoid sudden circulatory collapse. The postoperative cardiopulmonary condition was stable and PCPS was not required throughout the peri-operative period in this case. She was successfully weaned off the respirator and catecholamine administration was discontinued on 1^st postoperative day. Under the program of early rehabilitation, she recovered with no neurological sequelae and was discharged from the ICU on 4^th postoperative day. Acute massive pulmonary embolism has a high mortality rate and is a life threatening disorder that must be treated as soon as possible, and intensive care is essential to rescue these patients. For acute massive pulmonary embolism, early diagnosis and appropriate treatment greatly improve the mortality. When undertaking cardiopulmonary management including PCPS in patients who do not respond to the medical treatment or require the surgical treatment, we should make the coordination between departments in the hospital. It is necessary to have a consensus in the management of the acute pulmonary embolism and the multimodal intensive therapy that is to be provided.