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Levosimendan During VA-ECMO for Cardiogenic Shock: An Updated Systematic Review and Meta-analysis Including the
Zixuan Jiang1, Yueyue Zhang1, Ge Zhang1
1Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Journal of Cardiothoracic and Vascular Anesthesia
|August 13, 2026
Summary
Levosimendan use during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support did not improve weaning rates or reduce mortality, according to a meta-analysis. The apparent benefits were mainly from nonrandomized studies, not confirmed by the LEVOECMO trial.
Area of Science:
- Cardiology
- Critical Care Medicine
- Pharmacology
Background:
- Levosimendan is frequently administered during venoarterial extracorporeal membrane oxygenation (VA-ECMO) to aid in weaning.
- Existing evidence primarily stems from nonrandomized studies, raising concerns about treatment-timing bias.
Purpose of the Study:
- To conduct an updated systematic review and meta-analysis on levosimendan use during VA-ECMO.
- To incorporate data from the LEVOECMO randomized trial and recent comparative observational studies.
Main Methods:
- Searched multiple databases (PubMed/MEDLINE, Embase, Cochrane, Web of Science, etc.) up to May 21, 2026.
- Included adults with cardiogenic shock on VA-ECMO comparing levosimendan to no levosimendan, placebo, or standard care.
- Primary outcome: successful VA-ECMO weaning; secondary outcome: 28/30-day all-cause mortality.
Main Results:
- Nine studies (1 RCT, 8 observational) were analyzed.
- Overall, levosimendan showed a higher successful weaning rate (OR 1.60), but this was not significant in the RCT alone (OR 1.00).
- No significant reduction in 28/30-day mortality (OR 1.15) or difference in VA-ECMO duration was observed.
Conclusions:
- The perceived weaning benefit of levosimendan during VA-ECMO is primarily from nonrandomized studies and is not supported by the LEVOECMO randomized trial.
- Levosimendan does not reduce mortality and its routine use during VA-ECMO is not currently recommended.
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