Key result
Levosimendan use significantly reduced in-hospital mortality compared to control (46.3% vs 50.7%; RR 0.80, 95% CI 0.67-0.95, p=0.013) in patients undergoing VA-ECMO.
Why the study?
Although levosimendan reduces cardiogenic shock and facilitates weaning from cardiopulmonary bypass, its beneficial effects on hospital outcomes in patients receiving VA-ECMO remain uncertain.
Does levosimendan reduce in-hospital mortality in patients undergoing VA-ECMO?
Meta-Analysis (n=1,058)
Does levosimendan reduce in-hospital mortality in patients undergoing VA-ECMO?
Answers are grounded in this paper and cite their sources.
In patients undergoing VA-ECMO, levosimendan use is associated with a significant reduction in in-hospital mortality and a higher incidence of successful weaning.
Objective: Levosimendan has been demonstrated to reduce the incidence of cardiogenic shock and facilitate weaning from cardiopulmonary bypass. However, the beneficial effects of levosimendan treatment on hospital outcomes in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) are uncertain. We performed a systematic review and meta-analysis to evaluate the short-term effects of levosimendan use for patients undergoing VA-ECMO. Methods: We searched PubMed, Embase, and the Cochrane Library for English articles published from inception to July 15, 2021. Observational studies comparing levosimendan versus non- levosimendan for VA-ECMO were considered eligible for the current study. Results: Nine observational studies with 1058 patients were included. In-hospital mortality was 46.3% in the levosimendan group as compared with 50.7% in the control group. Levosimendan significantly reduced in-hospital mortality in patients undergoing VA-ECMO compared with the control group (RR, 0.80; 95% CI, 0.67–0.95; p = 0.013). The incidence of weaning from VA-ECMO was 79.3% in the levosimendan group as compared with 63.4% in the control group. Levosimendan significantly increase the incidence of weaning from VA-ECMO in patients as compared with the control group (RR, 1.20; 95% CI, 1.07–1.34; p = 0.002). In the one-way sensitivity analysis for estimating the effect of each study on mortality or weaning from VA-ECMO, omission of each study did not make a significant difference. Conclusions: Our study indicates that levosimendan use significantly reduced in-hospital mortality and increase the incidence of weaning in patients undergoing VA-ECMO.
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Yang et al. (2021) conducted a meta-analysis in Venoarterial extracorporeal membrane oxygenation (VA-ECMO) (n=1,058). Levosimendan vs. Control (non-levosimendan) was evaluated on In-hospital mortality (RR 0.80, 95% CI 0.67-0.95, p=0.013). Levosimendan use significantly reduced in-hospital mortality compared to control (46.3% vs 50.7%; RR 0.80, 95% CI 0.67-0.95, p=0.013) in patients undergoing VA-ECMO.
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