Levosimendan in patients with cardiogenic shock refractory to dobutamine weaning

Background The role of Levosimendan in managing cardiogenic shock remains the subject of debate. Objective This study examines the use and effects of Levosimendan when combined with dobutamine in patient’s refractory to dobutamine weaning. Methods This retrospective study included patients with cardiogenic shock admitted between January 1st, 2010, and October 31st, 2022. After initial dobutamine weaning failure, we compared patients who were treated with dobutamine alone versus those for whom Levosimendan was added in top of dobutamine. The primary outcome was successful inotrope withdrawal, defined as survival without catecholamine support, transplant, or definitive ventricular assist device at 30 days. Secondary outcomes included all-cause mortality at 30 and 90 days. Data analysis used inverse probability weighting according to propensity score. Results Among 349 patients with cardiogenic shock and failure to withdraw dobutamine, Levosimendan was used on top of dobutamine in 114 patients, and another try of dobutamine alone was made in 235 patients. At 30 days, successful inotrope withdrawal occurred in 46 (43.4%) patients with Levosimendan and dobutamine versus 24 (10.5%) patients of the dobutamine only group (weighted OR 4.99 [2.65 - 9.38]; p<0.001), with similar results at 90 days (weighted OR 6.16 [3.22-11.78]; p<0.001). Levosimendan + dobutamine was associated with lower 30-day mortality (weighted OR 0.47 [0.26-0.84]; p=0.01), with no difference at 90 days (weighted OR= 0.67 [0.39-1.14]; p=0.14). Conclusion Adding Levosimendan to dobutamine may improve inotrope withdrawal success and reduce 30-day mortality in patients with initial weaning failure, especially in those without project of cardiac assistance or transplant.