Objective:

Levosimendan has been demonstrated to reduce the incidence of cardiogenic shock and facilitate weaning from cardiopulmonary bypass. However, the beneficial effects of levosimendan treatment on hospital outcomes in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) are uncertain. We performed a systematic review and meta-analysis to evaluate the short-term effects of levosimendan use for patients undergoing VA-ECMO.

Methods:

We searched PubMed, Embase, and the Cochrane Library for English articles published from inception to July 15, 2021. Observational studies comparing levosimendan versus non- levosimendan for VA-ECMO were considered eligible for the current study.

Results:

Nine observational studies with 1058 patients were included. In-hospital mortality was 46.3% in the levosimendan group as compared with 50.7% in the control group. Levosimendan significantly reduced in-hospital mortality in patients undergoing VA-ECMO compared with the control group (RR, 0.80; 95% CI, 0.67–0.95; p = 0.013). The incidence of weaning from VA-ECMO was 79.3% in the levosimendan group as compared with 63.4% in the control group. Levosimendan significantly increase the incidence of weaning from VA-ECMO in patients as compared with the control group (RR, 1.20; 95% CI, 1.07–1.34; p = 0.002). In the one-way sensitivity analysis for estimating the effect of each study on mortality or weaning from VA-ECMO, omission of each study did not make a significant difference.

Conclusions:

Our study indicates that levosimendan use significantly reduced in-hospital mortality and increase the incidence of weaning in patients undergoing VA-ECMO.

中文翻译：

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左西孟旦用于静脉动脉体外膜肺氧合的短期影响：系统评价和荟萃分析

客观的：

左西孟旦已被证明可以降低心源性休克的发生率，并有助于脱离体外循环。然而，左西孟旦治疗对接受静脉动脉体外膜肺氧合 (VA-ECMO) 患者的医院结局的有益影响尚不确定。我们进行了一项系统回顾和荟萃分析，以评估左西孟旦对接受 VA-ECMO 患者的短期影响。

方法：

我们在 PubMed、Embase 和 Cochrane 图书馆中搜索了从成立到 2021 年 7 月 15 日发表的英文文章。比较左西孟旦和非左西孟旦对 VA-ECMO 的观察性研究被认为符合当前研究的条件。

结果：

包括 1058 名患者的 9 项观察性研究。左西孟旦组的院内死亡率为 46.3%，而对照组为 50.7%。与对照组相比，左西孟旦显着降低了接受 VA-ECMO 患者的院内死亡率（RR，0.80；95% CI，0.67–0.95；p = 0.013）。左西孟旦组从 VA-ECMO 撤机的发生率为 79.3%，而对照组为 63.4%。与对照组相比，左西孟旦显着增加了患者脱离 VA-ECMO 的发生率（RR，1.20；95% CI，1.07–1.34；p = 0.002）。在用于估计每项研究对死亡率或从 VA-ECMO 撤机的影响的单向敏感性分析中，每项研究的遗漏没有产生显着差异。

结论：

我们的研究表明，左西孟旦的使用显着降低了院内死亡率，并增加了接受 VA-ECMO 患者的撤机率。