Resection of locally advanced thoracic malignancies that require unplanned use of cardiopulmonary bypass, and injuries to the origins of major vessels or other intrapericardial structures could necessitate emergency cardiac surgical management. Thoracic surgeons without cardiac surgical training or recent practice involving use of cardiopulmonary bypass could need support from a cardiac surgeon in the emergency setting. In this chapter we will identify the pathologies and circumstances that may require cardiac surgical input, review the cardiopulmonary bypass (CPB)/extracorporeal membrane oxygenation (ECMO) and repair techniques utilised and describe mitigating mechanisms and practices for optimal outcomes. We will not cover the use of planned CPB/ECMO nor their role in lung transplantation.