Levosimendan During Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) for Cardiogenic Shock: An Updated Systematic Review and Meta-analysis Including the LEVOECMO Trial
Authors' conclusion
The apparent weaning benefit of levosimendan was driven mainly by nonrandomized evidence and was not confirmed by the LEVOECMO randomized trial.
Study context
- Population
- Adults with cardiogenic shock supported by VA-ECMO9 studies (1 RCT, 8 observational)
- Comparison
- Levosimendan vs no levosimendan, placebo or standard care during VA-ECMO
- Outcome
- Successful VA-ECMO weaning
Methodological detailsrandom-effects models, sensitivity analysis
- Random-effects models
- Sensitivity analysis
Pooled result
As reported in the abstract
Successful weaning, overall
Levosimendan vs No levosimendanOdds ratio (95% CI)P value
I² = 0%; 6 studies
1.60(1.17–2.17)
P = 0.003Randomised trial alone
1.00(0.56–1.81)
Further pooled results
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Successful VA-ECMO weaning, sensitivity analysis (RCT and propensity score-based studies)Attenuated, no longer significant | 1.53 (0.82–2.86) | P = 0.18 | |
| 28- or 30-day all-cause mortality (key secondary) · 28 or 30 daysI² = 0% | 1.15 (0.80–1.66) | P = 0.45 | |
| 0.20.5125Odds ratio (log scale) |
VA-ECMO duration (exploratory)
- No significant difference for VA-ECMO duration (MD, days)
- 0.28
- 95% CI −1.31 to 1.87; p = 0.73; I² = 83%
Safety
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Ventricular arrhythmias (exploratory)Numerically more frequent with levosimendan; imprecise | 1.65 (0.80–3.42) | P = 0.18 | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Levosimendan During VA-ECMO for Cardiogenic Shock: An Updated Systematic Review and Meta-analysis Including the LEVOECMO Trial. J Cardiothorac Vasc Anesth. Published 24 July 2026. doi:10.
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