The subscriber has a configurable, limited amount of time, known as the ackDeadline, to acknowledge the outstanding message. After the deadline passes, the message is no longer considered outstanding, and Pub/Sub attempts to redeliver the message.
You can also use synchronous pull with lease management since an individual message's processing may exceed the preconfigured acknowledgement deadline, also known as the lease. A good use case for synchronous pull with lease management is when you are processing hundreds of messages in parallel, and each message takes a long time to process.