title: Effects of Levosimendan on Endothelial Function and Hemodynamics During Weaning From Veno-Arterial Extracorporeal Life Support.
abstract: OBJECTIVE
  Weaning from veno-arterial extracorporeal life support is challenging. The objective of this trial was to investigate the endothelial and hemodynamic effects of levosimendan in cardiogenic shock patients supported with veno-arterial extracorporeal life support.
  
  
  METHODS
  This was a prospective observational trial.
  
  
  METHODS
  Cardiovascular intensive care unit of a large tertiary care university hospital in Monza, Italy.
  
  
  METHODS
  Flow-mediated dilatation of the brachial artery and hemodynamic parameters were assessed in 10 cardiogenic shock patients supported with veno-arterial extracorporeal life support, before and after the infusion of levosimendan.
  
  
  RESULTS
  Flow-mediated dilatation increased both as absolute value and as a percentage after levosimendan, from 0.10±0.12 to 0.61±0.21 mm (p<0.001) and from 3.2±4.2% to 17.8±10.4% (p<0.001), respectively. Cardiac index increased from 1.93±0.83 to 2.64±0.97 L/min/m2(p = 0.008) while mixed venous oxygen saturation increased from 66.0% to 71.5% (p = 0.006) and arterial lactate levels decreased from 1.25 to 1.05 mmol/L (p = 0.004) without significant variations in arterial oxygen saturation or hemoglobin levels. This made it possible for clinicians to reduce extracorporeal membrane oxygenation blood flow from 1.92±0.65 to 1.12±0.49 L/min/m2(p<0.001).
  
  
  CONCLUSIONS
  In conclusion, in the authors' study population of adult cardiogenic shock patients supported with veno-arterial extracorporeal life support, their observations supported the use of levosimendan to improve endothelial function and hemodynamics and facilitate weaning from the extracorporeal support.
authors: Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy. Electronic address: f.sangalli@hsgerardo.org.
authors: Fabio
authors: F
authors: Sangalli
authors: Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy.
authors: Leonello
authors: L
authors: Avalli
authors: Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy; University of Milan-Bicocca, Milan, Italy.
authors: Matteo
authors: M
authors: Laratta
authors: Cardiac Surgery Unit, San Gerardo Hospital, Monza, Italy; University of Milan-Bicocca, Milan, Italy.
authors: Francesco
authors: F
authors: Formica
authors: Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy.
authors: Elena
authors: E
authors: Maggioni
authors: Clinical Perfusion Service, San Gerardo Hospital, Monza, Italy.
authors: Rosa
authors: R
authors: Caruso
authors: Clinical Perfusion Service, San Gerardo Hospital, Monza, Italy.
authors: Maria
authors: M
authors: Cristina Costa
authors: Department of Cardiology, San Donato Hospital, University of Milan, Milan, Italy.
authors: Marco
authors: M
authors: Guazzi
authors: University of Milan-Bicocca, Milan, Italy; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Roberto
authors: R
authors: Fumagalli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output / Q000187:drug effects; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D011724:Pyridazines / Q000494:pharmacology*; D012770:Shock, Cardiogenic; D000077464:Simendan; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000494:pharmacology*; D015300:Ventilator Weaning / Q000379:methods
chemical_list: D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan; D010100:Oxygen
keywords: ECMO; cardiogenic shock; endothelial function; extracorporeal life support; hemodynamics; levosimendan