ASAIO Journal. 59(6):554–557, NOVEMBER/DECEMBER 2013
DOI: 10.1097/MAT.0b013e3182a4b32e
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PMID: 24172260
Issn Print: 1058-2916
Publication Date: November/December 2013
Levosimendan May Improve Weaning Outcomesin Venoarterial ECMO Patients
Alessandro Affronti;Isidoro di Bella;Davide Carino;Temistocle Ragni;
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From the Cardiac Surgery Department, Ospedale Santa Maria della Misericordia, Perugia, Italy.
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary mechanical circulatory support in patients with refractory cardiogenic shock, allowing time for cardiac recovery. Levosimendan is a calcium sensitizer with inotropic and vasodilatory effects used in the treatment of severe heart failure. It does not increase myocardial oxygen consumption. Its maximum hemodynamic response is seen 24–48 h after stopping infusion, but its effects can persist for 7–9 d owing to active metabolites. We sought to investigate whether the use of levosimendan improves weaning outcomes in patients on VA-ECMO. Six consecutive patients with cardiogenic shock were placed on femorofemoral VA-ECMO support and received levosimendan 24 h before the planned weaning (group A). As control group (group B), we retrospectively reviewed the VA-ECMO implanted at our institution before the introduction of the levosimendan protocol. These patients received only traditional inotropes. The weaning rate was 83.33% in group A and 27.3% in group B. The survival rate was 66.66% and 36.4%, respectively. In group A, three of six patients (50%) required inotropic/vasopressor support after ECMO cessation, while in group B 11 of 11 patients (100%) required support. In our case series, pretreatment with levosimendan seems to facilitate weaning from VA-ECMO, reducing the need for high-dose inotropes.
