Pediatric emergency resuscitative thoracotomy: A Western Trauma Association, Pediatric Trauma Society, and Eastern Association for the Surgery of Trauma collaborative critical decisions algorithm

The management of pediatric trauma patients with postinjury cardiopulmonary arrest or impending arrest requires rapid and sound clinical decision making that frequently includes consideration for performing an emergency resuscitative thoracotomy. This work provides an up-to-date and evidence-based approach to this process and to the selection of patients who may benefit from ERT, and those where the available evidence suggests little to no benefit. The primary selection for ERT in the pulseless pediatric patient should be based on the presence of any signs of life on hospital arrival and during the initial evaluation, and the anatomic injury pattern and not on injury mechanism alone or as a deciding factor.