A 61-year-old man fell into out-of hospital cardiopulmonary arrest due to rupture of an abdominal aortic aneurysm, and was resuscitated onsite. On arrival at the emergency room, a fusiform type abdominal aortic aneurysm and massive hematoma in the retro-peritoneal space were detected by ultrasonography. Quickly, an aortic occlusion balloon catheter was placed at the proximal site of abdominal aorta through the left brachial artery, and then graft replacement of the aneurysm was carried out. The inferior mesenteric artery was occluded, and was not reconstructed. Five hours after the operation, left hemi-colectomy was carried out for ischemic necrosis of the descending to sigmoid colon. Although he was complicated by multiple organ failure; renal failure, liver dysfunction, severe infection, and brain infarction, he survived without a fatal disability. A rare case with ruptured abdominal aortic aneurysm who fell into cardiopulmonary arrest outside the hospital but survived after bowel necrosis and multiple organ failure is reported.