Chen Yu-Wen, Lee Wei-Chieh, Wu Po-Jui, Fang Hsiu-Yu, Fang Yen-Nan, Chen Huang-Chung, Tong Meng-Shen, Sung Pei-Hsun, Lee Chieh-Ho, Chung Wen-Jung
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
College of Medicine, Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan.
Front Cardiovasc Med. 2022 Jun 30;9:912321. doi: 10.3389/fcvm.2022.912321. eCollection 2022.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in patients with refractory cardiogenic shock (CS) or out-of-hospital cardiac arrest. It is difficult to perform VA-ECMO weaning, which may cause circulatory failure and death. Levosimendan is an effective inotropic agent used to maintain cardiac output, has a long-lasting effect, and may have the potential benefit for VA-ECMO weaning. The study aimed to explore the relationship between the early use of levosimendan and the rate of VA-ECMO weaning failure in patients on VA-ECMO support for circulatory failure.
All patients who underwent VA-ECMO in our hospital for CS between January 2017 and December 2020 were recruited in this cohort study and divided into two groups: without and with levosimendan use. Levosimendan was used as an add-on to other inotropic agents as early as possible after VA-ECMO setting. The primary endpoint was VA-ECMO weaning success, which was defined as survival without events for 24 h after VA-ECMO withdrawl. The secondary outcomes were cardiovascular and all-cause mortality at the 30-day and 180-day follow-up periods post-VA-ECMO initialization.
A total of 159 patients were recruited for our study; 113 patients were enrolled in the without levosimendan-use group and 46 patients were enrolled in the levosimendan-use group. In levosimendan-use group, the patients received levosimendan infusion within 24 h after VA-ECMO initialization. Similar hemodynamic parameters were noted between the two groups. Poorer left ventricular ejection fraction and a higher prevalence of intra-aortic balloon pumping were observed in the levosimendan group. An improved weaning rate (without vs. with: 48.7 vs. 82.6%; < 0.001), lower in-hospital mortality rate (without vs. with: 68.1 vs. 43.5%; = 0.007), and 180-day cardiovascular mortality (without vs. with: 75.3 vs. 43.2%; < 0.001) were also noted. Patients administered with levosimendan also presented a lower rate of 30-day (without vs. with: 75.3 vs. 41.3%; = 0.034) and 180-day (without vs. with: 77.0 vs. 43.2%; < 0.001) all-cause mortality.
Early levosimendan administration may contribute to increasing the success rate of VA-ECMO weaning and may help to decrease CV and all-cause mortality.
静脉-动脉体外膜肺氧合（VA-ECMO）已越来越多地应用于难治性心源性休克（CS）或院外心脏骤停患者。VA-ECMO撤机困难，可能导致循环衰竭和死亡。左西孟旦是一种用于维持心输出量的有效强心剂，作用持久，可能对VA-ECMO撤机有潜在益处。本研究旨在探讨早期使用左西孟旦与接受VA-ECMO支持治疗循环衰竭患者的VA-ECMO撤机失败率之间的关系。
本队列研究纳入了2017年1月至2020年12月在我院接受VA-ECMO治疗CS的所有患者，并分为两组：未使用和使用左西孟旦组。在VA-ECMO建立后，左西孟旦尽早作为其他强心剂的补充药物使用。主要终点是VA-ECMO撤机成功，定义为VA-ECMO撤机后24小时无事件存活。次要结局是VA-ECMO启动后30天和180天随访期的心血管死亡率和全因死亡率。
本研究共纳入159例患者；113例患者纳入未使用左西孟旦组，46例患者纳入使用左西孟旦组。在使用左西孟旦组中，患者在VA-ECMO启动后24小时内接受左西孟旦输注。两组之间观察到相似的血流动力学参数。左西孟旦组观察到左心室射血分数较差和主动脉内球囊反搏使用率较高。还观察到撤机成功率提高（未使用组与使用组：48.7% vs. 82.6%；P<0.001），住院死亡率降低（未使用组与使用组：68.1% vs. 43.5%；P = 0.007），以及180天心血管死亡率降低（未使用组与使用组：75.3% vs. 43.2%；P<0.001）。接受左西孟旦治疗的患者30天（未使用组与使用组：75.3% vs. 41.3%；P = 0.034）和180天（未使用组与使用组：77.0% vs. 43.2%；P<0.001）全因死亡率也较低。
早期给予左西孟旦可能有助于提高VA-ECMO撤机成功率，并可能有助于降低心血管死亡率和全因死亡率。
