Key result
In patients with out-of-hospital cardiac arrest, levosimendan treatment was not significantly associated with 30-day mortality (OR 0.94; 95% CI 0.56-1.57; p=0.82).
Why the study?
Levosimendan improves resuscitation rates and cardiac performance in animal cardiac arrest models, but its use and association with outcome in out-of-hospital cardiac arrest patients needed description.
Does levosimendan reduce 30-day mortality in out-of-hospital cardiac arrest patients?
Observational (n=940)
Yes
Does levosimendan reduce 30-day mortality in out-of-hospital cardiac arrest patients?
In this observational cohort of out-of-hospital cardiac arrest patients, levosimendan use was not associated with a significant difference in 30-day mortality, though it was preferentially administered to sicker patients.
Answers are grounded in this paper and cite their sources.
Observational data should not alter levosimendan use in out-of-hospital cardiac arrest; leaves open need for randomized trials.
Background: Levosimendan improves resuscitation rates and cardiac performance in animal cardiac arrest models. The aim of this study was to describe the use of levosimendan in out-of-hospital cardiac arrest (OHCA) patients and its association with outcome. Methods: A retrospective observational study of OHCA patients admitted to six intensive care units in Stockholm, Sweden, between 2010 and 2016. Patients treated with levosimendan within 24 h from admission were compared with those not treated with levosimendan. Propensity score matching and multivariable logistic regression analysis were used to assess the association between levosimendan treatment and 30-day mortality Results: Levosimendan treatment was initiated in 94/940 (10%) patients within 24 h. The proportion of men (81%, vs. 67%, p = 0.007), initial shockable rhythm (66% vs. 37%, p < 0.001), acute myocardial infarction, AMI (47% vs. 24%, p < 0.001) and need for vasoactive support (98% vs. 61%, p < 0.001) were higher among patients treated with levosimendan. After adjustment for age, sex, bystander cardiopulmonary resuscitation, witnessed status, initial rhythm and AMI, the odds ratio (OR) for 30-day mortality in the levosimendan group compared to the no-levosimendan group was 0.94 (95% Confidence interval [CI], 0.56−1.57, p = 0.82). Similar results were seen when using a propensity score analysis comparing patients with circulatory shock. Conclusions: In this observational study of OHCA patients, levosimendan was used in a limited patient group, most often in those with initial shockable rhythms, acute myocardial infarction and with a high need for vasopressors. In this limited patient cohort, levosimendan treatment was not associated with 30-day mortality. However, a better matching of patient factors and indications for use is required to derive conclusions on associations with outcome.
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Rysz et al. (2022) conducted an observational in Out-of-hospital cardiac arrest (OHCA) (n=940). Levosimendan vs. No levosimendan was evaluated on 30-day mortality (OR 0.94, 95% CI 0.56-1.57, p=0.82). In patients with out-of-hospital cardiac arrest, levosimendan treatment was not significantly associated with 30-day mortality (OR 0.94; 95% CI 0.56-1.57; p=0.82).
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