Levosimendan for patients with heart failure undergoing major oncological surgery: A randomised blinded pilot study

Shaker, Ehab; Hussein, Khaled; Reyad, Ehab M.

doi:10.4103/ija.ija_548_18

Cited by 1 publication

(7 citation statements)

References 28 publications

(53 reference statements)

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“…In the sensitivity analysis, excluding any single trial did not significantly alter the overall combined OR (P-value ranging from <0.00001 to <0.0001). Similarly, subgroup analyses confirmed the higher successful weaning rates in patients with low LVEF and MV (27)(28)(29)31), patients with ECMO after cardiac surgery (11,17,24,30), and patients with ECMO and cardiogenic shock (9, 10, 15, 22, 25) (Figure 2). However, levosimendan showed no beneficial effect on patients with MV weaning difficulty than the control group (12,16,23,26) (Figure 2).…”

Section: Primary Outcomementioning

confidence: 63%

“…The main characteristics of included studies and predefined outcome measures are shown in Table 1 and Additional File 3 . Fourteen observational studies ( 9 – 11 , 15 – 17 , 22 – 26 , 30 – 32 ) and four RCTs ( 12 , 27 – 29 ) were included, which were conducted between 2009 and 2021. All but two studies ( 12 , 28 ) were single-center studies.…”

Section: Resultsmentioning

confidence: 99%

“…All but two studies ( 12 , 28 ) were single-center studies. Eight ( 12 , 16 , 23 , 26 – 29 , 31 ) of the 18 included trials focused on MV weaning, with or without low LVEF of the recruited patients. The remaining ten studies ( 9 – 11 , 15 , 17 , 22 , 24 , 25 , 30 , 32 ) focused on ECMO weaning, with five enrolling patients after cardiac surgery ( 11 , 17 , 24 , 30 , 32 ) and six enrolling patients suffering from cardiogenic shock ( 9 , 10 , 15 , 22 , 25 , 32 ).…”

Section: Resultsmentioning

confidence: 99%

“…We evaluated the included studies' risk of bias using the Newcastle-Ottawa Quality Assessment Scale for the 14 observational studies ( 9 – 11 , 15 – 17 , 22 – 26 , 30 – 32 ) and the Cochrane risk-of-bias tool for the four RCTs ( 12 , 27 – 29 ) ( Additional File 4 ). The quality of case-control/cohort studies was moderate to high, and the risk of bias in RCTs was low in all critical domains.…”

Section: Resultsmentioning

confidence: 99%

“…However, the results of our meta-analysis of clinical studies did not fully confirm this hypothesis. Patients who gained benefits from levosimendan during MV weaning are still those with concurrent low LVEF (27)(28)(29)31). For such a patient population, cardiac function is the most critical factor of weaning.…”

Section: Levosimendan In Weaning From MVmentioning

confidence: 99%

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Levosimendan to Facilitate Weaning From Cardiorespiratory Support in Critically Ill Patients: A Meta-Analysis

et al. 2021

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Background: Cardiopulmonary support, as extracorporeal membrane oxygenation (ECMO) or mechanical ventilation (MV), is crucial for ICU patients. However, some of these patients are difficult to wean. Therefore, we aimed to assess the efficacy and safety of levosimendan in facilitating weaning from cardiorespiratory support in this patient population.Methods: We searched for potentially relevant articles in PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and the Cochrane database from inception up to Feb 30, 2021. Studies focusing on weaning data in MV/ECMO adult patients who received levosimendan compared to controls were included. We used the Cochrane risk of bias tool or the Newcastle-Ottawa Quality Assessment Scale to evaluate the study quality. The primary outcome was the weaning rate from MV/ECMO. Secondary outcomes were mortality, duration of MV, and ICU stay. Subgroup analysis, sensitivity analysis, and publication bias were also conducted.Results: Eighteen studies with 2,274 patients were included. The quality of the included studies was low to moderate. Overall, levosimendan effectively improved weaning rates from MV/ECMO [odds ratio (OR) = 2.32; 95%CI, 1.60–3.36; P < 0.00001, I2 = 68%]. Subgroup analyses confirmed the higher successful weaning rates in ventilated patients with low left ventricular ejection fractions (OR = 4.06; 95%CI, 2.16–7.62), patients with ECMO after cardiac surgery (OR = 2.04; 95%CI, 1.25–3.34), and patients with ECMO and cardiogenic shock (OR = 1.98; 95%CI, 1.34–2.91). However, levosimendan showed no beneficial effect on patients with MV weaning difficulty (OR = 2.28; 95%CI, 0.72–7.25). Additionally, no differences were found concerning the secondary outcomes between the groups.Conclusions: Levosimendan therapy significantly increased successful weaning rates in patients with cardiopulmonary support, especially patients with combined cardiac insufficiency. Large-scale, well-designed RCTs will be needed to define the subgroup of patients most likely to benefit from this strategy.

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