The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis

Kaddoura, Rasha; Omar, Amr S; Ibrahim, Mohamed Izham Mohamed; Alkhulaifi, Abdulaziz; Lorusso, Roberto; Elsherbini, Hagar; Soliman, Osama Ibrahim Ibrahim; Çalışkan, Kadir

doi:10.1053/j.jvca.2021.01.019

Cited by 24 publications

(36 citation statements)

References 54 publications

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Section: Discussionsupporting

confidence: 92%

“…We found levosimendan facilitates the weaning from ECMO and reduces mortality rate, which is consistent with the findings of two previous meta-analyses ( 33 , 34 ). Both meta-analyses reported levosimendan could improve weaning from ECMO based on five ( N = 557) ( 34 ) and seven ( N = 630) ( 33 ) studies, respectively. Our study added several newly published studies based on the previous meta-analyses with a large sample size of 1,336 patients, which allowed for better statistical efficacy and allowed subgroup analyses to verify our results' robustness.…”

Section: Discussionsupporting

confidence: 92%

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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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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

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

et al. 2021

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“…A recent meta-analysis did not find a mortality benefit with the use of vasopressors and inotropes in CS complicating acute MI [112]. An emerging evidence highlighted the potential role of levosimendan in CS patients requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO), in facilitating VA-ECMO weaning and reducing all-cause mortality [113][114][115]. Unsurprisingly, the cardiology societal guidelines do not share a universal recommendation for the first-line agent in CS [96].…”

Section: Pharmacologic Circulatory Supportmentioning

confidence: 99%

Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome

Kaddoura¹,

Elbdri²

2021

Reviews in Cardiovascular Medicine

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Cardiogenic shock (CS) is a hemodynamically complex and highly morbid syndrome characterized by circulatory collapse and inadequate end-organ perfusion due to impaired cardiac output. It is usually associated with multiorgan failure and death. Mortality rate is still high despite advancement in treatment. CS has been conceptualised as a vicious cycle of injury and decompensation, both cardiac and systemic. Interrupting the vicious cycle and restoring the hemodynamic stability is a fundamental treatment of CS. Acute coronary syndrome (ACS) is the most frequent cause of CS. Early coronary revascularization is a cornerstone therapy that reduces mortality in patients with ACS complicated by CS. Early diagnosis of CS accompanied with invasive hemodynamics, helps in identification of CS phenotype, classification of CS severity, stratification of risk and prognostication. This can guide a tailored and optimized therapeutic approach. Inotropes and vasopressors are considered the firstline pharmacological option for hemodynamic instability. The current availability of the mechanical circulatory support devices has broadened the therapeutic choices for hemodynamic support. To date there is no pharmacological or nonpharmacological intervention for CS that showed a mortality benefit. The clinical practices in CS management remain inconsistent. Herein, this review discusses the current evidence in the diagnosis and management of CS complicating ACS, and features the changes in CS definition and classification.

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“…Inadequate end‐organ tissue perfusion characterizes circulatory compromise, such as cardiogenic shock, that leads to ischaemia and multiorgan failure with a high mortality rate. Temporary mechanical circulatory support devices, namely, venoarterial extracorporeal membrane oxygenation (VA‐ECMO), restore haemodynamic stability, improve tissue perfusion, allow time for the myocardium to recover, 1 and bridge patients to heart transplantation or durable mechanical circulatory support. 2 The prolonged use of VA‐ECMO is associated with complications such as thrombo‐embolic events, bleeding, limb ischaemia, brain or lung injury, and infection.…”

mentioning

confidence: 99%

“… 2 The prolonged use of VA‐ECMO is associated with complications such as thrombo‐embolic events, bleeding, limb ischaemia, brain or lung injury, and infection. 1 , 2 Early weaning is encouraged, because decreasing weaning failure may reduce VA‐ECMO‐related morbidity and mortality. 2 Successful weaning is still one of the main challenges following myocardial recovery.…”

mentioning

confidence: 99%

Levosimendan for VA‐ECMO weaning: the silver lining

2021

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The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis

Abstract: The effectiveness of levosimendan on veno-arterial extracorporeal membrane oxygenation management and outcome: a systematic review and meta-analysis,

Cited by 24 publications

References 54 publications

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

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

Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome

Levosimendan for VA‐ECMO weaning: the silver lining

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