First and foremost, my heartfelt thanks to ALL of you for your incredible contributions that have helped make virtual JC a worthwhile educational activity. This month, we are going to extend the theme of ED resuscitation into the realm of the traumatic arrest victim and the role of the ED thoracotomy. One of our time-honored suggestions for selecting a JC topic is to consider addressing seemingly disparate approaches to patient management. The decision-making regarding when to deploy an ED thoracotomy is an example represented by a range of approaches.  One of the biggest challenges is the paucity of RCT’s or other prospective high-quality data in this challenging patient population. Data is even less available in the pediatric patient population which of course, are some of the most difficult resuscitations to “call”. We have selected a few articles that are representative of the challenges and provide some insight into the Delphi method of developing guidelines based upon “expert opinion”,  typically considered the lowest source on the EBM pyramid.  

 Tran A, et al., Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest - A systematic review and meta-analysis. Resuscitation. 2020 Aug;153:119-135.

Burlew C. et al., Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg. 2012 Dec;73(6):1359-63.

Vassallo J, et al.,  Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation. Emerg Med J. 2018 Nov;35(11):669-674.

Traylor, M. Should Family be Permitted in the Trauma Bay? AMA J Ethics. 2018;20(5):455-463.