While emergency cardiac surgery represents 3–4% of the performed cardiac procedures in terms of acuteness, it accounts for a six fold, at least, increase in operative mortality compared to elective surgery. It stress-tests healthcare systems due to the requirement for increased resources, preparedness, and trained multidisciplinary teams in the core of which lies the modern cardiac surgeon. Strategies for early identification of precarious clinical conditions and support networks for high risk cardiological interventions could mitigate the incidence and improve the outcomes of emergency cardiac surgery. This also applies to cardiothoracic trauma, vascular interventions, and specific vulnerable populations such as those with congenital heart conditions and those awaiting heart transplantation. Emergency cardiac surgery lies in the intersection of these clinical disciplines and has not been examined in detail. It is often underreported in large databases and national audits, risk stratification models lack predictive value and specific training and education is sparse. This introductory chapter aims to better define emergency cardiac surgery and its asymmetric impact on outcomes and resources, and to identify potential strategies for risk management.