Levosimendan Effects Benefit Weaning from Veno-Arterial Extracorporeal Life Support

Background: Extracorporeal life support (ECLS) has proved to improve survival of patients with refractory cardiogenic shock even with the need of resuscitation. Nevertheless weaning these patients from ECLS can be challenging and prolonged ECLS is associated with complications. In this study we hypothesized that Levosimendan improves the chances of successful weaning of ECLS and survival.

Methods: We retrospectively reviewed 127 patients (mean age: 59.6 ± 12.7 years) that were in need of venoarterial (V-A) extracorporeal life support in the time between January 2013 and December 2016 in our institution. From 127 Patients 86 (67.7%) patients survived the first 48 hours and were considered to be weanable from ECLS and included in this study.

Results: 37 (43%) patients were treated with Levosimendan prior to ECLS flow reduction. Preoperative characteristics did not differ between both groups. Significantly more patients treated with Levosimendan have been weaned from ECLS compared with patients without Levosimendan therapy (64.8 vs. 32.6%, p = 0.003). Duration of ECLS therapy was comparable (182.4 h vs. 216 h, p = 0.21). In-hospital survival after ECMO weaning was significantly higher in patients treated with Levosimendan (51.3 vs. 23.4%, p = 0.005).

Conclusion: Levosimendan effects help to treat patients that were in need of ECLS and are about to be weaned from circulatory support. Weaning and survival was significantly higher after Levosimendan treatment and should be considered in every patient.