Is there a place for levosimendan in the intensive care unit?
BACKGROUND
Levosimendan is a novel calcium-sensitising agent that has been proposed as a potentially valuable inotrope for the treatment of acute or decompensated severe heart failure. Early clinical trials described some improvements in surrogate haemodynamic parameters, and suggested a possible survival benefit. However, before concluding that there is a place for routine use of levosimendan in the intensive care unit, a careful appraisal of all available evidence is needed.
Two phase II clinical trials, RUSSLAN and LIDO, have shown reduced mortality when levosimendan was compared with placebo and dobutamine, respectively. The CASINO study, yet to be fully reported, also purports to show a beneficial effect of levosimendan. In contrast, the two largest studies, REVIVE and SURVIVE -- also yet to be fully reported -- show no effect of levosimendan.


CONCLUSIONS
The best available evidence comes from the two large clinical trials, REVIVE and SURVIVE. These studies suggest that levosimendan does not improve survival for patients with acute severe heart failure. Until their results can be fully scrutinised, and placed in the context of all available evidence, we should conclude that there is no place for levosimendan in the ICU.
Delaney
Anthony
A
Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. adelaney@med.usyd.edu.au
Bradford
Celia
C
McCaffrey
John
J
Bagshaw
Sean M
SM
Lee
Richard
R
D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007362:Intensive Care Units; D011724:Pyridazines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D000077464:Simendan; D017211:Treatment Failure
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan