Case Report: Conversion from VA-ECMO to A-NRP for organ donation in a patient in asystole with Stanford A aortic dissection

Survival after cardiac arrest remains poor, with fewer than 10% of patients surviving out-of-hospital cardiac arrest. Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a strategy to address this unmet clinical need. Although ECPR is associated with improved survival and neurological outcomes compared to conventional care, a significant proportion of patients still present with irreversible anoxic brain injury. In that context, organ donation after circulatory death (DCD) may be proposed to families and represents an important opportunity to expand the donor pool. We report the case of a 63-year-old patient who presented with cardiac arrest secondary to a Stanford A type aortic root dissection. Following ECPR, the patient remained in persistent asystole. While supported on veno-arterial extracorporeal membrane oxygenation, he subsequently developed massive hemoptysis in the context of left atrial, ventricular, and pulmonary venous thrombosis. An emergency DCD procedure with abdominal normothermic regional perfusion (A-NRP) was performed, enabling successful kidney procurement and transplantation. Complete exclusion of the descending aorta using an aortic occlusion balloon resulted in immediate cessation of hemoptysis. This case illustrates an exceptional scenario in which ECPR performed in the setting of Stanford type A aortic dissection resulted in persistent asystole, complete left-sided cardiac, and massive hemoptysis. Given the confirmed irreversible prognosis and the previously expressed wish of the patient to donate organs, an emergency DCD procedure with A-NRP was the only viable strategy, ultimately allowing successful procurement and transplantation of one kidney.