REVIEW   

Minerva Cardiology and Angiology 2023 October;71(5):564-74

DOI: 10.23736/S2724-5683.22.06054-9

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Beneficial effects of levosimendan to wean patients from VA-ECMO: a systematic review and meta-analysis

Pietro BERTINI ¹ ✉, Gianluca PATERNOSTER ², Giovanni LANDONI ^{3, 4}, Marco FALCONE ⁵, Matteo NOCCI ⁶, Diego COSTANZO ⁷, Giulia BRIZZI ¹, Matteo ROMANI ⁷, Andrea ESPOSITO ⁸, Fabio GUARRACINO ¹

¹ Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; ² Division of Cardiac Resuscitation, Cardiovascular Anesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy, 3 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; ⁴ Vita-Salute San Raffaele University, Milan, Italy; ⁵ Infectious Disease Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy; ⁶ Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; ⁷ Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy; ⁸ Unit of Vascular Surgery, San Carlo Hospital, Potenza, Italy

INTRODUCTION: Patients with refractory cardiogenic shock can benefit from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The use of levosimendan in VA-ECMO patients may facilitate weaning and enhance survival.
EVIDENCE ACQUISITION: MEDLINE, Scopus, Web of Science, and Cochrane were searched from inception to October 10^th, 2021. Eligible clinical trials and observational studies reporting the use of levosimendan in VA-ECMO were searched. Two reviewers extracted data and independently assessed the risk of bias. To integrate the data, a random-effect model was applied. The success of weaning from VA-ECMO was the primary outcome.
EVIDENCE SYNTHESIS: Ten observational studies, including a total of 987 patients, were identified. Levosimendan was associated with successful weaning (362/448) compared with controls (328/539) (OR 2.37, 95% CI 1.71-3.28; P=0.01) and reduced mortality (144/433 vs. 258/507) (nine studies, OR 0.53, 95% CI 0.36-0.78; P=0.01) compared with control.
CONCLUSIONS: Levosimendan was associated with successful weaning and increased survival in VA-ECMO patients. Randomized trials should confirm these findings.

KEY WORDS: Cardiogenic shock; Extracorporeal membrane oxygenation; Weaning; Critical care; Meta-analysis; Mortality; Simendan