The effects of Levosimendan on global haemodynamics in patients with cardiogenic shock

Levosimendan may improve the outcome of acute heart failure patients with preserved arterial blood pressure. However, the data on its use in critically ill patients are scarce.

The aim of this study was to assess the effects of levosimendan on global haemodynamics in patients with cardiogenic shock.

Fourteen adult patients in cardiogenic shock were studied prospectively. One patient died after 10 hours and was excluded from final analysis. Haemodynamic monitoring included arterial and pulmonary arterial thermodilution catheters. Before levosimendan administration, 12 patients required norepinephrine, 6 patients dobutamine and 4 patients intraaortic balloon pump. Levosimendan was given as a bolus (12 microg x kg(-1) x 10 min(-1)) followed by 24 hrs infusion (0.1 microg x kg(-1) x min(-1)). Baseline data had been collected before levosimendan administration. Following data sets were obtained after 1, 8, 16 and 24 hours. Positive haemodynamic response was defined as an increase of > or = 30% in cardiac output.

Eleven patients met the criterion for the positive haemodynamic response. During levosimendan infusion systemic vascular resistance decreased (p<0.05) whereas cardiac output (p<0,001) and urine output increased (p<0.01). Mean arterial pressure and heart rate remained unchanged. No severe arrhythmias occurred and norepinephrine-dose did not change. Two patients were classified as non-responders.

Our results suggest that levosimendan infusion given as adjunctive therapy in patients with cardiogenic shock may be safe with beneficial effects on global haemodynamics.