The Role of Levosimendan in Extracorporeal Membrane Oxygenation for Refractory Cardiac Arrest

Abstract

ObjectivesTo examine whether levosimendan could improve survival in patients with cardiac arrest supported by extracorporeal cardiopulmonary resuscitation (ECPR). DesignA retrospective cohort study. SettingSingle tertiary academic center. ParticipantsPatients with refractory cardiac arrest. InterventionsPatients who were exposed to levosimendan and those who were not. Measurement and Main ResultsThere were 87 patients with a mean age of 45.4 ± 11.9 years, 86.2% of them were males with a mean body mass index of 26.8 ± 5.0 kg/m2, and a mean Charlson Comorbidity Index score of 0.7 ± 1.3. Of the 87 patients, 18 (20.7%) were administered levosimendan. The 2 groups were similar in terms of baseline characteristics. Overall, 70% of patients in both groups suffered in-hospital cardiac arrest and the remaining suffered out of hospital cardiac arrest. Median cardiopulmonary resuscitation duration before extracorporeal membrane oxygenation initiation was 54.0 minutes (interquartile range, 35.0–84.0 minutes). The highest lactate levels after between the second and the fourth days after ECPR were significantly higher (8.1 mmol/L vs 3.4 mmol/L; p = 0.046) and the duration of extracorporeal membrane oxygenation support was significantly longer (4.2 days vs 1.9 days; p = 0.0019) with levosimendan. There was no difference between the groups in terms of survival to decannulation (27.8% vs 26.1%), survival to hospital discharge (27.8% vs 24.6%), length of intensive care unit stay (19.1 vs 18.2 days), length of hospital stay (51.1 days vs 53.4 days), or complications rates (eg, infection, bleeding, and arrhythmias). ConclusionsLevosimendan use in ECPR did not improve survival. Future well-designed randomized trials are warranted to investigate the potential benefit of levosimendan in the ECPR setting.