CASE REPORT article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
Conversion from VA-ECMO to A-NRP for organ donation in a patient in asystole with Stanford A aortic dissection
Benjamin ASSOULINE 1,2
Franz IMMER 3,4
Philippe COMPAGNON 1,2
Charles-Henri Wassmer 1
Hervé QUINTARD 1,2
Giorgios GIANNAKOPOULOS 1
Birgit Andrea GARTNER 1,2
Karim Bendjelid 1,2
Raphael GIRAUD 1,2
1. Hopitaux Universitaires Geneve, Geneva, Switzerland
2. Universite de Geneve, Geneva, Switzerland
3. Universitat Bern, Bern, Switzerland
4. Swisstransplant, Bern, Switzerland
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Abstract
Survival after cardiac arrest remains poor, with less than 10% in out-of-hospital cardiac arrest (OHCA). Extracorporeal cardio-pulmonary resuscitation (ECPR) has been implemented to address this unmet clinical need. Despite improved survival and neurological outcomes compared to conventional care, a significant proportion of patients 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 a persistent asystole. While on VA-ECMO, he subsequently developed massive hemoptysis in the context of left atrial, ventricular and pulmonary venous thrombosis. An emergency DCD procedure with A-NRP was performed enabling the 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 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 patient's previously expressed wish to donate organs, emergency DCD procedure with A-NRP was the only viable strategy, ultimately allowing successful procurement and transplantation of one kidney.
Summary
Keywords
aortic dissection, ECPR, normothermic regional perfusion, organ procurement, Organ Transplantation, Refractory cardiac arrest, VA-ECMO
Received
27 October 2025
Accepted
12 January 2026
Copyright
© 2026 ASSOULINE, IMMER, COMPAGNON, Wassmer, QUINTARD, GIANNAKOPOULOS, GARTNER, Bendjelid and GIRAUD. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Raphael GIRAUD
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