Open chest CPR is NOT indicated in MWDs in an operational environment UNLESS CPA occurs during a thoracic or abdominal surgical procedure when the MWD is under general anesthesia. Cardiac massage can then be performed directly (if during a thoracic procedure) or through a trans-diaphragmatic approach (during an abdominal procedure).

This procedure should ONLY be attempted in these circumstances if the provider skill level and medical resources are sufficient. The MWD will require intensive critical care support post-operatively.