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

Objectives: To examine whether levosimendan could improve survival in patients with cardiac arrest supported by extracorporeal cardiopulmonary resuscitation (ECPR).

Design: A retrospective cohort study.

Setting: Single tertiary academic center.

Participants: Patients with refractory cardiac arrest.

Interventions: Patients who were exposed to levosimendan and those who were not.

Measurement And Main Results: There 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/m, 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).

Conclusions: 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.