Beneficial effects of levosimendan on survival in patients undergoing extracorporeal membrane oxygenation after cardiovascular surgery.
The impact of levosimendan treatment on clinical outcome in patients undergoing extracorporeal membrane oxygenation (ECMO) support after cardiovascular surgery is unknown. We hypothesized that the beneficial effects of levosimendan might improve survival when adequate end-organ perfusion is ensured by concomitant ECMO therapy. We therefore studied the impact of levosimendan treatment on survival and failure of ECMO weaning in patients after cardiovascular surgery.



We enrolled a total of 240 patients undergoing veno-arterial ECMO therapy after cardiovascular surgery at a university-affiliated tertiary care centre into our observational single-centre registry.



During a median follow-up period of 37 months (interquartile range 19-67 months), 65% of patients died. Seventy-five per cent of patients received levosimendan treatment within the first 24 h after initiation of ECMO therapy. Cox regression analysis showed an association between levosimendan treatment and successful ECMO weaning [adjusted hazard ratio (HR) 0.41; 95% confience interval (CI) 0.22-0.80; P=0.008], 30 day mortality (adjusted HR 0.52; 95% CI 0.30-0.89; P=0.016), and long-term mortality (adjusted HR 0.64; 95% CI 0.42-0.98; P=0.04).



These data suggest an association between levosimendan treatment and improved short- and long-term survival in patients undergoing ECMO support after cardiovascular surgery.
Department of Internal Medicine II.
K
K
Distelmaier
Department of Internal Medicine II.
C
C
Roth
Department of Internal Medicine II.
L
L
Schrutka
Department of Internal Medicine II.
C
C
Binder
Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
B
B
Steinlechner
Department of Internal Medicine II.
G
G
Heinz
Department of Internal Medicine II.
I M
IM
Lang
Department of Internal Medicine II.
G
G
Maurer
Department of Anaesthesia and Intensive Care Medicine, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria.
H
H
Koinig
Department of Internal Medicine II.
A
A
Niessner
Department of Internal Medicine II.
M
M
Hülsmann
Department of Internal Medicine II.
W
W
Speidl
Department of Internal Medicine II georg.goliasch@meduniwien.ac.at.
G
G
Goliasch
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D013504:Cardiovascular Surgical Procedures; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011724:Pyridazines / Q000627:therapeutic use*; D012042:Registries; D000077464:Simendan; D016019:Survival Analysis; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
cardiac surgery; extracorporeal membrane oxygenation; levosimendan; mortality; outcome