Thoracic trauma is one of the leading causes of death in all age groups and accounts for 25-50% of all traumatic injuries. While the majority of patients with thoracic trauma can be managed conservatively, a small but significant number requires emergency thoracotomy as part of their initial resuscitation. The procedure has been advocated for evacuation of pericardial tamponade, direct control of intrathoracic haemorrhage, control of massive air-embolism, open cardiac massage and cross-clamping of the descending aorta. Emergency thoracotomy can be defined as thoracotomy "occurring either immediately at the site of injury, or in the emergency department or operating room as an integral part of the initial resuscitation process". Following emergency thoracotomy, the overall survival rates for penetrating thoracic trauma are around 9-12% but have been reported to be as high as 38%. The survival rate for blunt trauma is approximately 1-2%. The decision to perform emergency thoracotomy involves careful evaluation of the scientific, ethical, social and economic issues. This article aims to provide a review of the current literature and to outline the pathophysiological features, technical manoeuvres and selective indications for emergency thoracotomy as a component of the initial resuscitation of trauma victims with thoracic injury.