Does Levosimendan hasten veno-arterial ECMO weaning? A
propensity score matching analysis
Annals
of Intensive Care volume 15,
Article number: 48 (2025) Published: 03 April 2025
Background
Preliminary evidence from small, single-center studies
suggests levosimendan may improve the likelihood of successful venoarterial
extracorporeal membrane oxygenation (VA-ECMO) weaning in patients with
cardiogenic shock. However, the literature is limited and presents conflicting
results. We aimed to assess the benefits of levosimendan on VA-ECMO for time to
successful ECMO weaning, using a pragmatic and rigorous definition of
successful VA-ECMO weaning in patients with potential for cardiac function recovery.
Methods
A retrospective bicentric study over 6 years was
conducted, including patients who received levosimendan during their ECMO
course. Patients with post-cardiotomy cardiogenic shock or end-stage chronic
heart failure were excluded. Patients receiving levosimendan while on VA-ECMO
were matched to those not receiving levosimendan during the same period, based
on pre-specified variables and time from ECMO initiation. The primary endpoint
was successful VA-ECMO weaning, defined as survival without death, heart transplantation,
or LVAD within 30 days after VA-ECMO withdrawal.
Results
Over the study period, 320 patients treated with VA-ECMO for
refractory cardiogenic shock were included, of whom 68 received levosimendan
during their ECMO course. Propensity score matching yielded 47 unique pairs of
patients with comparable characteristics. After matching, successful ECMO
weaning was achieved in 16 out of 47 patients (34%) in the no-levosimendan
group and 21 out of 47 patients (45%) in the levosimendan group (sHR, 1.45 [95%
CI, 0.77–2.70]; P = 0.25). Similarly, there were no
significant differences between the groups in terms of bridge-to-heart
transplant, LVAD, or death. Left ventricular ejection fraction and aortic
velocity time integral improved significantly after levosimendan in all patients,
regardless of their VA-ECMO weaning status.
Conclusion
In patients with non-postoperative cardiogenic shock
supported by peripheral VA-ECMO, levosimendan was not associated with increased
rates of successful VA-ECMO weaning or improved 30-day and 6-month bridge-free
survival. Results from double-blinded randomized controlled trials are urgently
needed to clarify the effectiveness and optimal timing of levosimendan in this
specific population.
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