Traumatic Arrest & Resuscitative Thoracotomy
Define management priorities and RT indications for patients in traumatic arrest.
Updated: 06/25/2025
RTCardiac arrestPenetratingCPROn this page3 sectionsHide sections
⚡RT Decision — Signs of Life ABSENT
▼| Mechanism | CPR Duration | Action |
|---|---|---|
| Blunt | Any | Attending discretion |
| Penetrating chest/abdomen | >15 min | Pronounce dead |
| Penetrating chest/abdomen | <15 min | Consider RT |
| Penetrating neck/extremity | >5 min | Pronounce dead |
| Penetrating neck/extremity | <5 min | Consider RT |
| Penetrating head | Any | Pronounce dead |
ℹ️
Signs of life PRESENT in bay → proceed with RT regardless of mechanism (except isolated penetrating head trauma).
🫀Signs of Life (any = positive)
▼- Spontaneous motor activity
- Spontaneous respirations
- Pupillary response to light
- Cardiac electrical activity (telemetry or US)
- Measurable BP
🩺Airway & Circulation
▼- Immediate ETI — no induction/paralytics needed
- Intentionally intubate right mainstem (isolates left lung for RT)
- 2 large bore IVs (16G+) or Cordis sheath — subclavian preferred
- Activate MTP, begin transfusion immediately
- TXA 2g IV
- Status
- AHS Official Protocol
- Source
- Traumatic_Arrest_CPG_AG.docx
- Last reviewed / updated
- 06/25/2025