Why the study?
Levosimendan use in patients on VA-ECMO for refractory cardiogenic shock may facilitate weaning and enhance survival, warranting systematic evaluation.
Does levosimendan improve weaning success and survival in patients with refractory cardiogenic shock on VA-ECMO?
Does levosimendan improve weaning success and survival in patients with refractory cardiogenic shock on VA-ECMO?
In a meta-analysis of observational studies, the use of levosimendan in patients on VA-ECMO for cardiogenic shock was associated with significantly higher rates of successful weaning and lower mortality.
May support levosimendan to aid VA-ECMO weaning in refractory shock; leaves open need for RCTs before practice change.
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: , 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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BERTINI et al. (2022) studied this question.
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