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

<h3>Objectives</h3><p dir="ltr">To examine whether levosimendan could improve survival in patients with cardiac arrest supported by extracorporeal cardiopulmonary resuscitation (ECPR). </p><h3>Design </h3><p dir="ltr"><u>Retrospective cohort study</u>. </p><h3>Setting</h3><p dir="ltr">Single tertiary academic center. </p><h3>Participants </h3><p dir="ltr">Patients with refractory cardiac arrest. </p><h3>Interventions </h3><p dir="ltr">Patients who were exposed to<u> levosimendan </u>and those who were not. </p><h3>Measurement and Main Results</h3><p dir="ltr">There were 87 patients with a mean age of 45.4 ± 11.9 years, 86.2% of them were males with a mean <u>body mass index</u> of 26.8 ± 5.0 kg/m², and a mean <u>Charlson Comorbidity</u> 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 <u>out of hospital cardiac arrest</u>. Median cardiopulmonary resuscitation duration before <u>extracorporeal membrane oxygenation</u> 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 <u>intensive care unit</u> stay (19.1 vs 18.2 days), length of hospital stay (51.1 days vs 53.4 days), or complications rates (eg, infection, <u>bleeding</u>, and arrhythmias). </p><h3>Conclusions</h3><p dir="ltr">Levosimendan 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.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Cardiothoracic and Vascular Anesthesia<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1053/j.jvca.2025.01.004" target="_blank">https://dx.doi.org/10.1053/j.jvca.2025.01.004</a></p>