The Impact of Levosimendan on Survival and Weaning from ECMO after Extracorporeal Cardiopulmonary Resuscitation.

OBJECTIVES: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared to conventional CPR. After cardiac arrest, the overall ejection fraction is severely impaired; thus, weaning from ECMO is often prolonged or impossible. We hypothesized that early application of levosimendan in these patients facilitates ECMO weaning and survival.

METHODS: From 2016 until 2020, patients who underwent eCPR after cardiac arrest at our institution were analyzed retrospectively and divided into two groups: patients who received levosimendan during ICU stay (n=24) and those who did not receive levosimendan (n=84) and analyzed for outcome parameters. Furthermore, we used propensity-score matching and multinomial regression analysis to show the effect of levosimendan on outcome parameters.

RESULTS: Overall, in-hospital mortality was significantly lower in the group which received levosimendan (28% vs. 88%, p=<0.01), and ECMO weaning was more feasible in patients that received levosimendan (88% vs. 20%, p=<0.01). CPR duration until ECMO cannulation was significantly shorter in the levosimendan group (44+26 vs. 65+28, p=0.002); interestingly, the rate of mechanical chest compressions before ECMO cannulation was lower in the levosimendan group (50% vs. 69%, p=0.005).

CONCLUSION: In patients after cardiac arrest treated with eCPR, Levosimendan seems to contribute to higher success rates of ECMO weaning, potentially due to a short to mid-term increase in inotropy. Also, the survival after Levosimendan application was higher than patients who did not receive levosimendan.