Based on the above, patients must meet each of the following strict consensus criteria for progression to pre-hospital resuscitative thoracotomy (RT):

• penetrating thoracic/epigastric injury
  
• in witnessed cardiac arrest (i.e. signs of life immediately following injury and preceding loss of output)
  
• attended within 10 minutes of loss of output
  
• tension pneumothorax excluded as cause.

Currently, any other indication for pre-hospital RT is insufficiently supported by evidence and therefore difficult to justify; however, there is increasing support for RT in proximal haemorrhage control following penetrating abdominal injury.

Absolute contraindications are based on futility of RT:

• medical cardiac arrest
  
• downtime more than 10 minutes.

Blunt trauma, severe head injury and damage to more than one body region are associated with very poor outcomes and also currently preclude RT. It should also be noted, however, that in practice, it is often difficult to establish precise time of loss of output and as such RT is often carried out when downtime is unclear.