Heart Failure, Pulmonary Hypertension and Transplant Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina.
Critical Care Cardiology Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina.
Perfusion. 2020 Sep;35(6):484-491. doi: 10.1177/0267659120918473. Epub 2020 May 24.
Veno-arterial extracorporeal membrane oxygenation may be used to support patients with refractory cardiogenic shock. Many patients can be successfully weaned, the ability of some medications to facilitate weaning from veno-arterial extracorporeal membrane oxygenation were reported. To date, there are limited studies investigating the impact of levosimendan on veno-arterial extracorporeal membrane oxygenation weaning. The objective of this systematic review and meta-analysis was to assess the effects of levosimendan on successful weaning from veno-arterial extracorporeal membrane oxygenation and survival in adult patients with cardiogenic shock.
We performed a systematic review and meta-analysis (PubMed, the Cochrane Library, and the International Clinical Trials Registry Platform published from the year 2000 onwards) investigating whether levosimendan offers advantages compared to standard therapy or placebo, in cardiogenic shock adult patients treated with veno-arterial extracorporeal membrane oxygenation. The primary outcome was veno-arterial extracorporeal membrane oxygenation successful weaning, whereas secondary outcome was all-cause mortality at the longest follow-up available. We pooled risk ratio and 95% confidence interval using fixed and random effects models according to the heterogeneity.
A total of five non-randomized clinical trials comprising 557 patients were included, 299 patients for levosimendan and 258 patients for control groups. The pooled prevalence of veno-arterial extracorporeal membrane oxygenation successful weaning was 61.4% (95% confidence interval 39.8-82.9%), and all-cause mortality was 36% (95% confidence interval 29.6-48.8%). There was a significant increase in veno-arterial extracorporeal membrane oxygenation successful weaning with levosimendan compared to the controls (risk ratio = 1.42 (95% confidence interval 1.12-1.8), p for effect = 0.004, I = 71%). A decrease risk of all-cause mortality in the levosimendan group was also observed, risk ratio = 0.62 (95% confidence interval 0.44-0.88), p for effect = 0.007, I = 36%.
The use of levosimendan on adult patients with cardiogenic shock may facilitate the veno-arterial extracorporeal membrane oxygenation weaning and reduce all-cause mortality. Few articles of this topic are available, and prospective, randomized multi-center trials are warranted to conclude decisively on the benefits of levosimendan in this setting.
静脉-动脉体外膜肺氧合可用于支持难治性心源性休克患者。许多患者可以成功撤机，一些药物能够促进静脉-动脉体外膜肺氧合撤机，已有报道。迄今为止，关于左西孟旦对静脉-动脉体外膜肺氧合撤机影响的研究有限。本系统评价和荟萃分析的目的是评估左西孟旦对心源性休克患者成功撤机和生存的影响。
我们进行了系统评价和荟萃分析（从 2000 年开始在 PubMed、Cochrane 图书馆和国际临床试验注册平台上发表的文章），调查左西孟旦与标准治疗或安慰剂相比，在接受静脉-动脉体外膜肺氧合治疗的心源性休克成年患者中的优势。主要结局是静脉-动脉体外膜肺氧合成功撤机，次要结局是最长随访时间的全因死亡率。我们根据异质性使用固定效应模型和随机效应模型汇总风险比和 95%置信区间。
共有 5 项非随机临床试验纳入了 557 名患者，其中 299 名患者接受左西孟旦治疗，258 名患者接受对照组治疗。静脉-动脉体外膜肺氧合成功撤机的总患病率为 61.4%（95%置信区间为 39.8%-82.9%），全因死亡率为 36%（95%置信区间为 29.6%-48.8%）。与对照组相比，左西孟旦组静脉-动脉体外膜肺氧合成功撤机的比例显著增加（风险比=1.42（95%置信区间为 1.12-1.8），p 值为效应=0.004，I=71%）。左西孟旦组全因死亡率的风险也有所降低，风险比=0.62（95%置信区间为 0.44-0.88），p 值为效应=0.007，I=36%。
左西孟旦在心源性休克成年患者中的应用可能有助于静脉-动脉体外膜肺氧合撤机，并降低全因死亡率。关于这个主题的文章很少，需要前瞻性、多中心随机试验来最终确定左西孟旦在这种情况下的益处。
