Cardiopulmonary Bypass Before Anesthesia Induction in a Case of Ruptured Ascending Aortic Aneurysm.

Management of ruptured ascending aortic aneurysms causing hemodynamic compromise represents a major challenge, especially during induction of anesthesia. We present a case of ruptured ascending aortic aneurysm with cardiac tamponade and cardiogenic shock, managed by awake cardiopulmonary bypass to avoid hemodynamic collapse. This represents an unconventional approach to establishing cardiopulmonary bypass, which in most cases is done postinduction. Increased surgical bleeding from full heparinization before sternotomy can be a problem, limiting visibility.