Pericardial Decompression for Acute Traumatic Cardiac Tamponade-Pearls and Clamshells.

Acute traumatic cardiac tamponade is a time-critical-but potentially reversible-cause of circulatory collapse. The surgical, operative, nursing and anaesthesiology staff most capable and best trained to perform the procedure are often not immediately available, requiring emergency medical staff to perform this life-saving intervention. When tamponade causes refractory shock or peri-arrest, left anterolateral thoracotomy remains the preferred technique for definitive pericardial decompression, with extension to a clamshell thoracotomy when required.