Open-chest cardiac massage is usually done on an individual undergoing surgery whose chest is already open and whose heart stops beating effectively. On occasion, if a cardiac arrest occurs a few hours or days after chest surgery, the chest is reopened to institute open-chest cardiac massage. The procedure may also be used in an individual with gunshot or stab wounds to the chest (penetrating trauma) whose heart stops beating in the emergency department.
The cause of cardiopulmonary arrest is usually an intraoperative event, such as a reaction to anesthetics or other drugs, massive hemorrhage, a pulmonary embolus, high potassium, or an air embolus. A trauma-related arrest is due to an injury of a major blood vessel, the lungs, or the heart.