Gross — Saddle Pulmonary Embolus Bifurcation

A 58-year-old man with a 2-week history of left leg swelling and pain presents to the emergency department with acute-onset dyspnea, chest pain, and syncope. His blood pressure is 78/52 mmHg despite fluid resuscitation, and he is in acute respiratory distress. A CT pulmonary angiogram shows a large thrombus straddling the bifurcation of the main pulmonary artery, as marked **A** in the diagram. Which of the following best describes the hemodynamic classification and immediate management priority for this presentation?