Rysz Susanne, Fagerlund Malin Jonsson, Lundberg Johan, Ringh Mattias, Hollenberg Jacob, Lindgren Marcus, Jonsson Martin, Djärv Therese, Nordberg Per
Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76 Stockholm, Sweden.
Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden.
J Clin Med. 2022 May 6;11(9):2621. doi: 10.3390/jcm11092621.
Background: Levosimendan improves resuscitation rates and cardiac performance in animal cardiac arrest models. The aim of this study was to describe the use of levosimendan in out-of-hospital cardiac arrest (OHCA) patients and its association with outcome. Methods: A retrospective observational study of OHCA patients admitted to six intensive care units in Stockholm, Sweden, between 2010 and 2016. Patients treated with levosimendan within 24 h from admission were compared with those not treated with levosimendan. Propensity score matching and multivariable logistic regression analysis were used to assess the association between levosimendan treatment and 30-day mortality Results: Levosimendan treatment was initiated in 94/940 (10%) patients within 24 h. The proportion of men (81%, vs. 67%, p = 0.007), initial shockable rhythm (66% vs. 37%, p < 0.001), acute myocardial infarction, AMI (47% vs. 24%, p < 0.001) and need for vasoactive support (98% vs. 61%, p < 0.001) were higher among patients treated with levosimendan. After adjustment for age, sex, bystander cardiopulmonary resuscitation, witnessed status, initial rhythm and AMI, the odds ratio (OR) for 30-day mortality in the levosimendan group compared to the no-levosimendan group was 0.94 (95% Confidence interval [CI], 0.56−1.57, p = 0.82). Similar results were seen when using a propensity score analysis comparing patients with circulatory shock. Conclusions: In this observational study of OHCA patients, levosimendan was used in a limited patient group, most often in those with initial shockable rhythms, acute myocardial infarction and with a high need for vasopressors. In this limited patient cohort, levosimendan treatment was not associated with 30-day mortality. However, a better matching of patient factors and indications for use is required to derive conclusions on associations with outcome.
左西孟旦可提高动物心脏骤停模型的复苏率和心脏功能。本研究旨在描述左西孟旦在院外心脏骤停（OHCA）患者中的应用及其与预后的关系。方法：对2010年至2016年期间入住瑞典斯德哥尔摩6个重症监护病房的OHCA患者进行回顾性观察研究。将入院后24小时内接受左西孟旦治疗的患者与未接受左西孟旦治疗的患者进行比较。采用倾向评分匹配和多变量逻辑回归分析来评估左西孟旦治疗与30天死亡率之间的关联。结果：940例患者中有94例（10%）在24小时内开始接受左西孟旦治疗。接受左西孟旦治疗的患者中男性比例（81%对67%，p = 0.007）、初始可电击心律比例（66%对37%，p < 0.001）、急性心肌梗死（AMI）比例（47%对24%，p < 0.001）以及血管活性药物支持需求比例（98%对61%，p < 0.001）更高。在对年龄、性别、旁观者心肺复苏、目击情况、初始心律和AMI进行调整后，左西孟旦组与未使用左西孟旦组相比，30天死亡率的比值比（OR）为0.94（95%置信区间[CI]，0.56 - 1.57，p = 0.82）。在比较循环性休克患者时，使用倾向评分分析也得到了类似结果。结论：在这项针对OHCA患者的观察性研究中，左西孟旦应用于有限的患者群体，最常见于初始可电击心律、急性心肌梗死且对血管加压药需求高的患者。在这个有限的患者队列中，左西孟旦治疗与30天死亡率无关。然而，需要更好地匹配患者因素和使用指征，才能得出与预后关联的结论。
