Purpose: This study assesses the mortality and procedural determinants in emergency thoracotomy (ET) at Liverpool Hospital, highlighting the procedure's significance for trauma patients requiring pre-hospital CPR or in profound shock. Methodology: We conducted a retrospective analysis of the trauma database from 2014-2023 to identify patients who underwent ET pre-hospital, in the ED, or OT. Parameters assessed included mortality rates, length of stay (LOS), injury severity score (ISS), and time to procedure, with a focus on identifying factors contributing to mortality and morbidity including mechanism, procedural timing, team experience and complications. Results: The study included 22 patients (median age 35.5; 19 males, 3 females), comprising 6 blunt trauma and 16 penetrating trauma cases. In-hospital ET had an average time-to-procedure of 124 minutes. The overall mortality rate was 73%, with blunt trauma at 83% and penetrating trauma at 69%. Pre-ED thoracotomies had a 100% mortality rate. Mortality rates for ET were 83% in the ED and 37% in the OT. The average LOS was 10.3 days. Conclusion: ET demonstrates a high mortality rate, especially for pre-hospital interventions, indicating its severity and the critical nature of the injuries involved. This study highlights the near futility of pre-hospital thoracotomies in our setting and brings into question our protocols in pre-hospital management of such patients. A deeper understanding of the factors contributing to mortality is essential for improving patient outcomes and revisiting current practices for ET interventions.