The following is a summary of “Does Levosimendan hasten veno-arterial ECMO weaning? A propensity score matching analysis,” published in the April 2025 issue of Annals of Intensive Care by Paulo et al. 

Preliminary studies from small, single-center trials indicated that levosimendan could have increased the likelihood of successful venoarterial extracorporeal membrane oxygenation (VA-ECMO) weaning in individuals with cardiogenic shock, though findings remained limited and inconsistent.  

Researchers conducted a retrospective study to evaluate the effects of levosimendan on time to successful VA-ECMO weaning using a pragmatic and rigorous definition in individuals with potential for cardiac function recovery.  

They performed a 6-year bicentric study, including individuals who received levosimendan during VA-ECMO. Those with post-cardiotomy cardiogenic shock or end-stage chronic heart failure were excluded. Participants receiving levosimendan during VA-ECMO were matched with those who did not, using pre-specified variables and time from ECMO initiation. The primary endpoint was successful VA-ECMO weaning, defined as survival without death, heart transplantation, or left ventricular assist device (LVAD) implantation within 30 days after VA-ECMO withdrawal.  

The results showed that 320 individuals received VA-ECMO for refractory cardiogenic shock, with 68 receiving levosimendan. Propensity score matching created 47 comparable pairs. Successful ECMO weaning occurred in 16 of 47 (34%) without levosimendan and 21 of 47 (45%) with levosimendan (subdistribution hazard ratio [sHR], 1.45 [95% CI, 0.77–2.70]; P = 0.25). No significant differences were observed in bridge-to-heart transplant, LVAD use, or mortality. Left ventricular ejection fraction (LVEF) and aortic velocity time integral (AoVTI) improved after levosimendan, regardless of VA-ECMO weaning status.  

Investigators concluded that levosimendan did not improve VA-ECMO weaning success or survival in non-postoperative patients with cardiogenic shock supported by peripheral VA-ECMO. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01457-9