PMID- 33583718
OWN - NLM
STAT- MEDLINE
DCOM- 20210722
LR  - 20210722
IS  - 1532-8422 (Electronic)
IS  - 1053-0770 (Linking)
VI  - 35
IP  - 8
DP  - 2021 Aug
TI  - The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane 
      Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis.
PG  - 2483-2495
LID - S1053-0770(21)00054-9 [pii]
LID - 10.1053/j.jvca.2021.01.019 [doi]
AB  - OBJECTIVES: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides 
      a temporary support system for patients with cardiogenic shock refractory to 
      conventional medical therapies. It has been reported that levosimendan may 
      facilitate VA-ECMO weaning and improve survival. The primary objective of this 
      review was to examine the effect of levosimendan use on VA-ECMO weaning and 
      mortality in critically ill patients on VA-ECMO. DESIGN: MEDLINE, EMBASE, and 
      CENTRAL were searched. A pair of reviewers identified eligible clinical trials. 
      Two reviewers extracted data and independently assessed the risk of bias. A 
      random-effect model was used to combine data. The primary outcome was the success 
      of weaning from VA-ECMO. MEASUREMENTS AND MAIN RESULTS: Seven studies of 
      observational design, including a total of 630 patients, were selected in the 
      final analysis. The sample size ranged from ten-to-240 patients, with a mean age 
      between 53 and 65 years, and more than half of them underwent cardiac surgeries. 
      The VA-ECMO durations varied between four and 11.6 days. Overall, levosimendan 
      use was significantly associated with successful weaning compared with control 
      (odds ratio [OR] 2.89, 95% CI, 1.53-5.46; p(overall effect) = 0.001); 
      I(2) = 49%). For survival, six studies (n = 617) were included in the 
      meta-analysis involving 326 patients in the levosimendan group and 291 in the 
      comparator group. Pooled results showed a significantly higher survival rate in 
      the levosimendan group (OR 0.46, 95% CI, 0.30-0.71; p(overall effect) = 0.0004; 
      I(2) = 20%). CONCLUSIONS: Levosimendan therapy was significantly associated with 
      successful weaning and survival benefit in patients with cardiogenic or 
      postcardiotomy shock needing VA-ECMO support for severe cardiocirculatory 
      compromise. To date, there is limited literature and absence of evidence from 
      randomized trials addressing the use of levosimendan in VA-ECMO weaning. This 
      study may be considered a hypothesis-generating research for randomized 
      controlled trials to confirm its findings.
CI  - Copyright (c) 2021 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Kaddoura, Rasha
AU  - Kaddoura R
AD  - Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar. 
      Electronic address: rkaddoura@hamad.qa.
FAU - Omar, Amr S
AU  - Omar AS
AD  - Department of Cardiothoracic Surgery/Cardiac Anesthesia & ICU, Heart Hospital, 
      Hamad Medical Corporation, Doha, Qatar.
FAU - Ibrahim, Mohamed Izham Mohamed
AU  - Ibrahim MIM
AD  - Faculty of Pharmacy, Qatar University, Doha, Qatar.
FAU - Alkhulaifi, Abdulaziz
AU  - Alkhulaifi A
AD  - Department of Cardiothoracic Surgery/Cardiac Anesthesia & ICU, Heart Hospital, 
      Hamad Medical Corporation, Doha, Qatar.
FAU - Lorusso, Roberto
AU  - Lorusso R
AD  - Maastricht University Medical Centre (MUMC) Cardiovascular Research Institute, 
      Maastricht (CARIM) Maastricht University, Roterdam, Netherlands.
FAU - Elsherbini, Hagar
AU  - Elsherbini H
AD  - Cardiology, Erasmus University Medical Center, Roterdam, Netherlands.
FAU - Soliman, Osama
AU  - Soliman O
AD  - National University of Ireland Galway, Galway, Ireland.
FAU - Caliskan, Kadir
AU  - Caliskan K
AD  - Cardiology, Erasmus University Medical Center, Roterdam, Netherlands.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20210116
PL  - United States
TA  - J Cardiothorac Vasc Anesth
JT  - Journal of cardiothoracic and vascular anesthesia
JID - 9110208
RN  - 349552KRHK (Simendan)
SB  - IM
CIN - J Cardiothorac Vasc Anesth. 2021 Aug;35(8):2496-2498. PMID: 34006467
MH  - Aged
MH  - *Cardiac Surgical Procedures
MH  - *Extracorporeal Membrane Oxygenation
MH  - Humans
MH  - Middle Aged
MH  - Randomized Controlled Trials as Topic
MH  - *Shock
MH  - Shock, Cardiogenic/drug therapy
MH  - Simendan
OTO - NOTNLM
OT  - ECLS
OT  - cardiogenic shock
OT  - extracorporeal life support
OT  - extracorporeal membrane oxygenation
OT  - levosimendan
OT  - weaning
EDAT- 2021/02/16 06:00
MHDA- 2021/07/23 06:00
CRDT- 2021/02/15 05:40
PHST- 2020/11/23 00:00 [received]
PHST- 2021/01/01 00:00 [revised]
PHST- 2021/01/09 00:00 [accepted]
PHST- 2021/02/16 06:00 [pubmed]
PHST- 2021/07/23 06:00 [medline]
PHST- 2021/02/15 05:40 [entrez]
AID - S1053-0770(21)00054-9 [pii]
AID - 10.1053/j.jvca.2021.01.019 [doi]
PST - ppublish
SO  - J Cardiothorac Vasc Anesth. 2021 Aug;35(8):2483-2495. doi: 
      10.1053/j.jvca.2021.01.019. Epub 2021 Jan 16.