Impact of levosimendan on weaning from peripheral venoarterial extracorporeal membrane oxygenation in intensive care unit

• Published in: Annals of intensive care Vol. 9; no. 1; pp. 24 - 9
• Main Authors: Vally, Shamir, Ferdynus, Cyril, Persichini, Romain, Bouchet, Bruno, Braunberger, Eric, Lo Pinto, Hugo, Martinet, Olivier, Vandroux, David, Aujoulat, Thomas, Allyn, Jérôme, Allou, Nicolas
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2019; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; Confidence intervals; Critical Care Medicine; Drug therapy; Ejection fraction; Emergency Medicine; Extracorporeal membrane oxygenation; Intensive; Intensive care; Levosimendan; Medical procedures; Medicine; Medicine & Public Health; Mortality; Respiratory therapy; Weaning; Extracorporeal membrane oxygenation; Levosimendan; Weaning; Mortality
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-019-0503-1

Background
Few data are available on the impact of levosimendan in refractory cardiogenic shock patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The aim of this study was to evaluate the impact of levosimendan on VA-ECMO weaning in patients hospitalized in intensive care unit (ICU).
Methods
This retrospective cohort study was conducted in a French university hospital from 2010 to 2017. All patients hospitalized in ICU undergoing VA-ECMO were consecutively evaluated.
Results
A total of 150 patients undergoing VA-ECMO were eligible for the study. Thirty-eight propensity-matched patients were evaluated in the levosimendan group and 65 in the non-levosimendan group. In patients treated with levosimendan, left ventricular ejection fraction had increased from 21.5 ± 9.1% to 30.7 ± 13.5% (
P
 < 0.0001) and aortic velocity–time integral from 8.9 ± 4 cm to 12.5 ± 3.8 cm (
P
 = 0.002) 24 h after drug infusion. After propensity score matching, levosimendan was the only factor associated with a significant reduction in VA-ECMO weaning failure rates (hazard ratio = 0.16; 95% confidence interval 0.04–0.7;
P
 = 0.01). Kaplan–Meier survival curves showed that survival rates at 30 days were 78.4% for the levosimendan group and 49.5% for the non-levosimendan group (
P
 = 0.02). After propensity score matching analysis, the difference in 30-day mortality between the two groups was not significant (hazard ratio = 0.55; 95% confidence interval 0.27–1.10;
P
 = 0.09).
Conclusions
Our results suggest that levosimendan was associated with a beneficial effect on VA-ECMO weaning in ICU patients.