Diagnosis of brain death and consecutive donor management under combined circulatory support with ECMELLA therapy

Background Managing brain death determination (BDD) in potential organ donors is a challenging aspect of modern intensive care medicine. In critically ill patients with implanted circulatory or left ventricular support devices, standard recommendations for BDD are often no longer applicable.Methods/results The available recommendations and evidence for BDD and organ procuring under ECMELLA therapy-a combined circulatory support using a veno-arterial extracorporeal membrane oxygenation (vaECMO) and an invasive left ventricular support device (Impella (R) CP)-are discussed based on a clinical case. To the authors' knowledge, this is the first report of BDD under ECMELLA therapy.Conclusion Although BDD in patients with multimodal invasive circulatory support, such as ECMELLA therapy, is demanding and time-intensive, it can still be performed safely and based on evidence. Given the continuing low numbers of organ donors, these insights may help to facilitate organ donation in patients with combined invasive mechanical circulatory support.