Beneficial effects of levosimendan to wean patients from VA-ECMO: a systematic review and meta-analysis
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Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Pietro Bertini1, Gianluca Paternoster2, Giovanni Landoni3,4
1Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy - pietro.bertini@gmail.com.
Introduction:
Patients with refractory cardiogenic shock can benefit from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The use of levosimendan in VA-ECMO patients may facilitate weaning and enhance survival.
Evidence Acquisition:
MEDLINE, Scopus, Web of Science, and Cochrane were searched from inception to October 10th, 2021. Eligible clinical trials and observational studies reporting the use of levosimendan in VA-ECMO were searched. Two reviewers extracted data and independently assessed the risk of bias. To integrate the data, a random-effect model was applied. The success of weaning from VA-ECMO was the primary outcome.
Evidence Synthesis:
Ten observational studies, including a total of 987 patients, were identified. Levosimendan was associated with successful weaning (362/448) compared with controls (328/539) (OR 2.37, 95% CI 1.71-3.28; P=0.01) and reduced mortality (144/433 vs. 258/507) (nine studies, OR 0.53, 95% CI 0.36-0.78; P=0.01) compared with control.
Conclusions:
Levosimendan was associated with successful weaning and increased survival in VA-ECMO patients. Randomized trials should confirm these findings.
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