Effects of Levosimendan on Endothelial Function and Hemodynamics During Weaning From Veno-Arterial Extracorporeal Life Support

Objective: Weaning from veno-arterial extracorporeal life support is challenging. The objective of this trial was to investigate the endothelial and hemodynamic effects of levosimendan in cardiogenic shock patients supported with veno-arterial extracorporeal life support. Design: This was a prospective observational trial. Setting: Cardiovascular intensive care unit of a large tertiary care university hospital in Monza, Italy. Participants and Interventions: Flow-mediated dilatation of the brachial artery and hemodynamic parameters were assessed in 10 cardiogenic shock patients supported with veno-arterial extracorporeal life support, before and after the infusion of levosimendan. Measurements and Results: Flow-mediated dilatation increased both as absolute value and as a percentage after levosimendan, from 0.10 +/- 0.12 to 0.61 +/- 0.21 mm (p < 0.001) and from 3.2 +/- 4.2% to 17.8 +/- 10.4% (p < 0.001), respectively. Cardiac index increased from 1.93 +/- 0.83 to 2.64 +/- 0.97 L/min/m(2) (p = 0.008) while mixed venous oxygen saturation increased from 66.0% to 71.5% (p = 0.006) and arterial lactate levels decreased from 1.25 to 1.05 mmol/L (p = 0.004) without significant variations in arterial oxygen saturation or hemoglobin levels. This made it possible for clinicians to reduce extracorporeal membrane oxygenation blood flow from 1.92 +/- 0.65 to 1.12 +/- 0.49 L/min/m(2) (p < 0.001). Conclusion: In conclusion, in the authors' study population of adult cardiogenic shock patients supported with veno-arterial extracorporeal life support, their observations supported the use of levosimendan to improve endothelial function and hemodynamics and facilitate weaning from the extracorporeal support. (C) 2016 Elsevier Inc. All rights reserved.