Levosimendan to facilitate weaning from cardiorespiratory support in critically ill patients: current evidence and future directions

Sangalli, Fabio; Bellani, Giacomo; Affronti, Alessandro; Volpi, Francesca; Feri, Marco; Marini, Marco; Quacquarelli, Antonio; Vitale, Domenico; Guarracino, Fabio

doi:10.23736/s0375-9393.20.14219-6

Cited by 12 publications

(11 citation statements)

References 34 publications

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“…Furthermore, levosimendan bears pleiotropic and anti‐oxidative effects including protection of myocardial, renal, and hepatic cells from ischemia/reperfusion injury 13 . These effects theoretically may promote the myocardial recovery and could facilitate successful withdrawal of different therapies in critically cardiovascular patients such as other inotropic drugs, mechanical ventilation, or MCS 14‐16 . After the VA‐ECMO removal, an increase in the doses of inotropic and vasoactive drugs may be necessary.…”

Section: Discussionmentioning

confidence: 99%

Levosimendan in veno‐arterial extracorporeal membrane oxygenator supported patients: Impact on the success of weaning and survival

Alonso-Fernández-Gatta

Merchán-Gómez

González-Cebrián

et al. 2021

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Weaning failure and mortality rates in veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) supported patients are significant. Small studies suggest the possible usefulness of levosimendan in this environment, especially in postcardiotomy shock. We performed a retrospective analysis of VA‐ECMO implants in a referral hospital comparing weaning failure and survival of patients treated with levosimendan with a control group. From 2013 to May 2020, 123 VA‐ECMO for several indications were implanted. Levosimendan was administered in 23 patients (18.7%) with good tolerance. Levosimendan was used more frequently in cardiogenic shock due to acute coronary syndrome indication, and in patients with lower left ventricular ejection fraction (LVEF) at the implant. No significant differences were found in success of ECMO weaning (60.9% levosimendan group vs. 44% non‐levosimendan group, P = .169) despite worse LVEF in levosimendan group. Survival at follow‐up (20.6 [58] months) was higher in the group that received levosimendan, although without finding statistically significant differences (47.8% vs. 32.0%, log rank P = .124). Levosimendan can be safely administered during VA‐ECMO support. Patients receiving levosimendan were weaned similarly from circulatory support despite worse LVEF. Its use did not influence in short‐ and medium‐term survival. Randomized studies are needed to evaluate the levosimendan impact in this indication.

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Section: Discussionmentioning

confidence: 99%

Levosimendan in veno‐arterial extracorporeal membrane oxygenator supported patients: Impact on the success of weaning and survival

Alonso-Fernández-Gatta

Merchán-Gómez

González-Cebrián

et al. 2021

Artificial Organs

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“…Pending the results of WEANILEVO and other investigations, the algorithms recently advocated by Sangalli et al [ 55 ] may provide a starting point for pragmatic discussions of how to locate levosimendan in the weaning pathway (Fig. 3 ).…”

Section: Weaning From Va-ecmomentioning

confidence: 99%

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

Girardis

Béttex

Bojan

et al. 2022

J Anesth Analg Crit Care

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The inodilator levosimendan, in clinical use for over two decades, has been the subject of extensive clinical and experimental evaluation in various clinical settings beyond its principal indication in the management of acutely decompensated chronic heart failure. Critical care and emergency medicine applications for levosimendan have included postoperative settings, septic shock, and cardiogenic shock. As the experience in these areas continues to expand, an international task force of experts from 15 countries (Austria, Belgium, China, Croatia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Spain, Sweden, Switzerland, and the USA) reviewed and appraised the latest additions to the database of levosimendan use in critical care, considering all the clinical studies, meta-analyses, and guidelines published from September 2019 to November 2021. Overall, the authors of this opinion paper give levosimendan a “should be considered” recommendation in critical care and emergency medicine settings, with different levels of evidence in postoperative settings, septic shock, weaning from mechanical ventilation, weaning from veno-arterial extracorporeal membrane oxygenation, cardiogenic shock, and Takotsubo syndrome, in all cases when an inodilator is needed to restore acute severely reduced left or right ventricular ejection fraction and overall haemodynamic balance, and also in the presence of renal dysfunction/failure.

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“…Factors thought to contribute to this phenomenon include pulmonary congestion owing to HF and the development of diaphragm weakness. The pathophysiology of diaphragm weakness includes altered calcium sensitivity of the contractile proteins, so it is plausible that levosimendan may improve prospects for successful weaning in some patients [89].…”

Section: Weaning From Respiratory and Circulatory Supportmentioning

confidence: 99%

An update on levosimendan in acute cardiac care: applications and recommendations for optimal efficacy and safety

Heringlake¹,

Álvarez

Béttex

et al. 2021

Expert Review of Cardiovascular Therapy

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Introduction: In the 20 years since its introduction to the palette of intravenous hemodynamic therapies, the inodilator levosimendan has established itself as a valuable asset for the management of acute decompensated heart failure. Its pharmacology is notable for delivering inotropy via calcium sensitization without an increase in myocardial oxygen consumption. Areas covered: Experience with levosimendan has led to its applications expanding into perioperative hemodynamic support and various critical care settings, as well as an array of situations associated with acutely decompensated heart failure, such as right ventricular failure, cardiogenic shock with multiorgan dysfunction, and cardio-renal syndrome. Evidence suggests that levosimendan may be preferable to milrinone for patients in cardiogenic shock after cardiac surgery or for weaning from extracorporeal life support and may be superior to dobutamine in terms of short-term survival, especially in patients on beta-blockers. Positive effects on kidney function have been noted, further differentiating levosimendan from catecholamines and phosphodiesterase inhibitors. Expert opinion:Levosimendan can be a valuable resource in the treatment of acute cardiac dysfunction, especially in the presence of beta-blockers or ischemic cardiomyopathy. When attention is given to avoiding or correcting hypovolemia and hypokalemia, an early use of the drug in the treatment algorithm is preferred.

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Levosimendan to facilitate weaning from cardiorespiratory support in critically ill patients: current evidence and future directions

Cited by 12 publications

References 34 publications

Levosimendan in veno‐arterial extracorporeal membrane oxygenator supported patients: Impact on the success of weaning and survival

Levosimendan in veno‐arterial extracorporeal membrane oxygenator supported patients: Impact on the success of weaning and survival

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

An update on levosimendan in acute cardiac care: applications and recommendations for optimal efficacy and safety

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