Following initial stabilization, advanced care is often indicated. If oxygenation or ventilation is inadequate, an advanced airway is indicated, ensuring the stability of the cervical spine. If this is not possible, an alternative is a cricothyrotomy. Providers should evaluate for traumatic injuries such as pneumothorax, diaphragm injury, and hemothorax. Cardiovascular stability is also vital, and control of bleeding is necessary to support hemodynamic status. Replacement with intravascular volume can be necessary. Management of cardiac arrhythmias underlying arrest is key with a rapid assessment of the common reversible causes. Remember that significant bradycardia or asystole may be secondary to significant blood loss, acidosis, or hypoxemia. Treat shockable rhythms with defibrillation if present. 

There may be a benefit of thoracotomy for resuscitation. Research shows that its use decreases a nearly 100% mortality rate to between 89 and 98% for penetration and blunt injuries, respectively. Determination of the requirements needed to start or end resuscitation should be reviewed based on trauma guidelines.