In her ethnography of surgeons and their art, Joan Cas-sell spoke of operations and their outcomes as "expected miracles."1 Surely there is no greater surgical miracle than raising the dead. It is therefore expected and understandable that a responsible surgeon, faced with a wounded patient suddenly without signs of life, should attempt resus-citative thoracotomy in the emergency department (EDT).In this issue of the Journal of the American College of Surgeons, Passos and colleagues2 share an unblinking look at the outcomes of 123 such procedures performed at a single Level 1 trauma center in Toronto. There were 3 survivors with good neurological outcomes, a typical and respectable record. What sets this report apart from other reviews of EDT outcomes is the authors' willingness to sort the EDT record into those procedures performed for appropriate and for inappropriate indications.
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