The data is becoming quite clear. For a trauma patient, who is not intubated, I have not been able to find a survivor who has had pre hospital CPR for more than 5 minutes, including our own data going back to 1960 on our trauma registry. If the patient has been intubated and is a victim of trauma and has had prehospital CPR for more than 10 minutes, we have never had a survivor. If the initial pH is 6.8 or less, in a patient with a traumatic arrest, we have not ever had a survivor. I do not hesitate to spend this money if there is a chance for reversal, but I think we are irresponsible to pour a lot of money down the drain when everyone knows that this patient in front of us has NO chance of survival, and if we do coax the heart back the cost in the expensive care unit for a person with a dead brain, but a beating heart in an intubated patient is awsome.
Death is virtually always inevitable.
That is disrespectful of the dead. Generally, if the monitor shows flat-line, we do nothing further. Other factors to consider include whether there were vital signs in the field and how long ago they were, how long the ambulance ride was, and if the trauma was blunt or penetrating. Blunt trauma has a prohibitably low yield, as well as long ambulance rides, and the absence of vital signs in the field. You are on solid ground if you chose not open the chest in these situations.