The resuscitative thoracotomy is a lifesaving surgical procedure in the emergent treatment of selected trauma patients. To be effective, this difficult procedure must be performed accurately and quickly. The surgeon must have an in-depth understanding of the procedural principles and surgical techniques; there is rarely time for bedside teaching of this operation. We have undertaken this project to collate and present the best procedural and technical information, based on our trauma center's accumulated experience of over 1,000 resuscitative thoracotomies.