{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T09:32:29Z","timestamp":1787909549537,"version":"build-2784847793"},"reference-count":83,"publisher":"Springer Science and Business Media LLC","issue":"S7","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Johannes Kepler University Linz"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Wien Klin Wochenschr"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Resuscitative thoracotomy (RT) is recommended for selected patients with traumatic cardiac arrest, particularly after penetrating trauma; however, most evidence is derived from high-volume centers, creating uncertainty about its implementation in settings with a\u00a0low prevalence of penetrating injuries. This study aimed to develop evidence-informed, consensus-based recommendations for the systematic implementation of RT in such contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A\u00a0modified Delphi process was conducted with 24\u00a0specialists representing 10\u00a0Austrian medical societies and two emergency medical services. A\u00a0systematic literature review was carried out to enable the development of 22\u00a0open-ended questions. Responses from the first round were synthesized into 28\u00a0statements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Consensus was achieved on all 28\u00a0statements after 4\u00a0rounds, with participation rates of 100% in rounds 1 and 2, and 91.7% in rounds 3 and\u00a04. The panel issued 1\u00a0strong recommendation, 15\u00a0weak recommendations and 12\u00a0best-practice statements. Agreement was unanimous in 17.9%, strong in 50.0%, and moderate in 32.1% of the statements. Evidence certainty was rated as moderate (18.8%), low (43.8%) or very low (37.5%). Key recommendations emphasized strict indication criteria, system level prerequisites such as major trauma centers and physician-led emergency services, preference for the clamshell technique and the need for structured multidisciplinary training and governance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This consensus provides guidance on implementing RT in settings with a\u00a0low prevalence of penetrating trauma. Careful patient selection, system preparedness and structured training are essential to optimize outcomes. These recommendations can support clinicians and policymakers in their decision if and how RT should be implemented into trauma systems with limited exposure to penetrating injuries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00508-026-02771-3","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:46:50Z","timestamp":1781603210000},"page":"623-640","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Resuscitative thoracotomy in traumatic cardiac arrest"],"prefix":"10.1007","volume":"138","author":[{"given":"Martin W.","family":"D\u00fcnser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Grassmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Hamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Krammel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Eller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Eisenburger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romana","family":"Erblich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Hallmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Halmich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Hellwagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Herbich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Herkner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Knez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas L.","family":"Negrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Rigaud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Schlieber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Schnaubelt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Schreiber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra-Maria","family":"Stommel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Tomaselli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Trimmel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Veigl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Voelckel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Watzka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Wiedemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Puchwein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,13]]},"reference":[{"key":"2771_CR1","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s44158-024-00197-9","volume":"4","author":"L Carenzo","year":"2024","unstructured":"Carenzo\u00a0L, Calgaro\u00a0G, Rehn\u00a0M, et\u00a0al. 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CJEM. 2023;25:768\u201375. https:\/\/doi.org\/10.1007\/s43678-023-00576-1.","journal-title":"CJEM"}],"container-title":["Wiener klinische Wochenschrift"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-026-02771-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00508-026-02771-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-026-02771-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:04:43Z","timestamp":1782219883000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00508-026-02771-3"}},"subtitle":["Multisociety consensus recommendations for settings with a\u00a0low prevalence of penetrating injuries"],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":83,"journal-issue":{"issue":"S7","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["2771"],"URL":"https:\/\/doi.org\/10.1007\/s00508-026-02771-3","relation":{},"ISSN":["0043-5325","1613-7671"],"issn-type":[{"value":"0043-5325","type":"print"},{"value":"1613-7671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"11 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"D.\u00a0Grassmann, B.\u00a0Hallmann, T.\u00a0Hamp, M.\u00a0Krammel, P.\u00a0Puchwein, and M.\u00a0Rigaud are members of the instructor faculty of the Viennese Resuscitative Thoracotomy (VieRT) Course. D.\u00a0Grassmann is the course director of the VieRT Course, received surgical instruments for training purposes by B.\u00a0Braun Austria, and received an unrestricted medical educational grant by Teleflex. D.\u00a0Wiedemann declared the following potential conflicts of interest (all unrelated to the topic of resuscitative thoracotomy): lecture honoraria from Abiomed, Abbott, LivaNova, and Edwards Lifesciences; advisory board member Xenios\/Fresenius; research grant by Medtronics to the Department of Cardiac Surgery at the University Hospital St. P\u00f6lten (Director and department chair: D.\u00a0Wiedemann). M.\u00a0Krammel received lecture honoraria from Stryker and Zoll. S.\u00a0Watzka received lecture honoraria from AstraZeneca, Bristol-Myers Squibb and Merck Sharp & Dohme. M.W.\u00a0D\u00fcnser is section editor with the\n                      Wiener Klinische Wochenschrift\n                      but was not involved in the editorial management of this manuscript. P.\u00a0Eller, P.\u00a0Eisenburger, R.\u00a0Erblich, M.\u00a0Halmich, K.\u00a0Hellwagner, K.\u00a0Herbich, H.\u00a0Herkner, I.\u00a0Knez, L.L.\u00a0Negrin, J.\u00a0Schlieber, S.\u00a0Schnaubelt, W.\u00a0Schreiber, A.-M.\u00a0Stommel, F.\u00a0Tomaselli, H.\u00a0Trimmel, C.\u00a0Veigl and W.\u00a0Voelckel declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}