At StartHQ (https://starthq.com) we've abstracted away all async code with a sync layer using fibers and that has served us well over the past year, but I can totally see how trying to mix the two would have been a recipe for disaster.
Here is a video of a talk we gave on this: http://www.youtube.com/watch?v=pmyDJnEza6A and here are the slides: http://www.slideshare.net/olegp/start-hq-server-side