This guideline has been endorsed by EAST and uses Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology a framework recently adopted by EAST.

Since its first formal description nearly 50 years ago, emergency department thoracotomy (EDT) has remained among the most polarizing and controversial procedures that physicians perform. When treating moribund trauma victims presenting in extremis, clinicians are forced to make immediate life-or-death decisions for their patients—decisions that attempt to balance the last chance of survival with the risk of salvaging patients with severe anoxic encephalopathy or exposing health care providers to blood-borne pathogens. Limited salvage rates in conjunction with considerable potential risks associated with EDT have been central to the controversy. These reported outcomes have led to a more discriminating focus on patients most likely to benefit from the heroic procedure while limiting unnecessary risk. A selective approach to the performance of EDT based on the presence or absence of several predictors of survival has thus emerged. The primary objective of this article is to provide clear evidence-based recommendations for the physician facing the most common presenting clinical scenarios after critical injury. These recommendations are meant to provide an evidence-based framework from which clinicians can make rapid decisions regarding further resuscitation with EDT or futility.

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