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

• Main Authors: Shamir Vally, Cyril Ferdynus, Romain Persichini, Bruno Bouchet, Eric Braunberger, Hugo Lo Pinto, Olivier Martinet, David Vandroux, Thomas Aujoulat, Jérôme Allyn, Nicolas Allou
• Format: Article
• Language: English
• Published: SpringerOpen 2019-02-01
• Series: Annals of Intensive Care
• Subjects: Extracorporeal membrane oxygenation; Levosimendan; Weaning; Mortality
• Online Access: http://link.springer.com/article/10.1186/s13613-019-0503-1

Abstract 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.