Figure 1.

Traumatic cardiac arrest and thoracotomy algorithm. *If signs of exsanguination or chest injuries, external chest compressions unlikely to be effective, and possibly detrimental. **In blunt trauma involving complex pathology, pericardiocentesis maybe a reasonable intermediate step. If ROSC not achieved, proceed to immediate thoracotomy. ALS, advanced cardiac life support; BVM, bag valve mask; ECG, electrocardiogram; ETCO2, end-tidal carbon dioxide partial pressure; ETI, endotracheal intubation; ILCOR, International Liaison Committee on Resuscitation; IPPV, intermittent positive pressure ventilation; MTC, major trauma centre; MTP, massive transfusion policy; ROSC, return of spontaneous circulation; SGA, supra-glottic airway; VF, ventricular fibrillation; VT, ventricular tachycardia.