Purpose: Managing patients with hemorrhagic shock is mainly dependent on stopping the bleedingas fast as possible. Emergency Department laparotomy (EDL) is considered one of the approachesto control intra-abdominal bleeding rapidly. This study aims to evaluate the outcomes of EDL in aregional trauma center of Pusan National University Hospital in a 4-year period. Methods: The medical records and data of patients who underwent EDL from January 2016 toDecember 2019 were analyzed. Patients who underwent preperitoneal pelvic packing only or did notreceive surgery immediately after EDL were excluded. Results: Twenty-four patients who underwent EDL were included in the study. 18 patients hadsustained blunt trauma, and 6 suffered from penetrating injuries. Small bowel mesentery and liverinjuries were the most frequent. Increase of median systolic blood pressure (SBP) after EDL was 55.5mmHg. Four (16.7%) out of the 24 survived; one of the four survivors received cardiopulmonaryresuscitation (CPR). In the nonsurvivor group, Injury Severity Score was significantly higher (p =0.013), initial pH was lower (p = 0.035) and the amount of packed red blood cells transfusion afterEDL was significantly higher (p = 0.013) than those in the survivor group. Conclusion: The mortality rate was very high in trauma patients who were required EDL. AlthoughEDL was not proved to be an effective procedure for resuscitation in trauma patients, it could beconsidered as one of the treatment options for trauma patients in extremis. Further studies arerequired to examine the effects of EDL.