Emergency department thoracotomy (EDT) is defined as a thoracotomy performed in the emergency department for patients who are in extremis. The goals of the procedure are to treat pericardial tamponade, control hemorrhage, treat systemic air embolism, perform open cardiac massage and temporarily occlude the thoracic aorta. The lack of clarity in the medical literature, the need for rapid intervention in those patients deemed appropriate for the procedure, the life and death nature of the decision, and the low but finite functional survival rates following EDT for trauma, have made the conduct of this procedure a subject of great controversy among trauma experts. In this brief review, we summarize the available literature, technical concerns and indications for the procedure. We aim to provide suitable information for individual readers to refine their approach to EDT.