The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis
<h3>Objectives</h3><p dir="ltr">Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides a temporary support system for patients with cardiogenic shock refractory to conventional medical therapies. It has been reported that levosimendan may facilitate VA-ECMO...
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| مؤلفون آخرون: | , , , , , , |
| منشور في: |
2021
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| الموضوعات: | |
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| _version_ | 1864513551500050432 |
|---|---|
| author | Rasha Kaddoura (12506936) |
| author2 | Amr S. Omar (16932537) Mohamed Izham Mohamed Ibrahim (10221287) Abdulaziz Alkhulaifi (16932540) Roberto Lorusso (5193650) Hagar Elsherbini (16932543) Osama Soliman (4539073) Kadir Caliskan (3441230) |
| author2_role | author author author author author author author |
| author_facet | Rasha Kaddoura (12506936) Amr S. Omar (16932537) Mohamed Izham Mohamed Ibrahim (10221287) Abdulaziz Alkhulaifi (16932540) Roberto Lorusso (5193650) Hagar Elsherbini (16932543) Osama Soliman (4539073) Kadir Caliskan (3441230) |
| author_role | author |
| dc.creator.none.fl_str_mv | Rasha Kaddoura (12506936) Amr S. Omar (16932537) Mohamed Izham Mohamed Ibrahim (10221287) Abdulaziz Alkhulaifi (16932540) Roberto Lorusso (5193650) Hagar Elsherbini (16932543) Osama Soliman (4539073) Kadir Caliskan (3441230) |
| dc.date.none.fl_str_mv | 2021-01-16T00:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1053/j.jvca.2021.01.019 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/The_Effectiveness_of_Levosimendan_on_Veno-Arterial_Extracorporeal_Membrane_Oxygenation_Management_and_Outcome_A_Systematic_Review_and_Meta-Analysis/24083697 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Cardiovascular medicine and haematology Clinical sciences cardiogenic shock ECLS extracorporeal life support extracorporeal membrane oxygenation levosimendan weaning |
| dc.title.none.fl_str_mv | The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <h3>Objectives</h3><p dir="ltr">Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides a temporary support system for patients with cardiogenic shock refractory to conventional medical therapies. It has been reported that levosimendan may facilitate VA-ECMO weaning and improve survival. The primary objective of this review was to examine the effect of levosimendan use on VA-ECMO weaning and mortality in critically ill patients on VA-ECMO.</p><h3>Design</h3><p dir="ltr">MEDLINE, EMBASE, and CENTRAL were searched. A pair of reviewers identified eligible clinical trials. Two reviewers extracted data and independently assessed the risk of bias. A random-effect model was used to combine data. The primary outcome was the success of weaning from VA-ECMO.</p><h3>Measurements and Main Results</h3><p dir="ltr">Seven studies of observational design, including a total of 630 patients, were selected in the final analysis. The sample size ranged from ten-to-240 patients, with a mean age between 53 and 65 years, and more than half of them underwent cardiac surgeries. The VA-ECMO durations varied between four and 11.6 days. Overall, levosimendan use was significantly associated with successful weaning compared with control (odds ratio [OR] 2.89, 95% CI, 1.53-5.46; p<sub>overall effect</sub> = 0.001); I<sup>2</sup> = 49%). For survival, six studies (n = 617) were included in the meta-analysis involving 326 patients in the levosimendan group and 291 in the comparator group. Pooled results showed a significantly higher survival rate in the levosimendan group (OR 0.46, 95% CI, 0.30-0.71; p<sub>overall effect</sub> = 0.0004; I<sup>2</sup> = 20%).</p><h3>Conclusions</h3><p dir="ltr">Levosimendan therapy was significantly associated with successful weaning and survival benefit in patients with cardiogenic or postcardiotomy shock needing VA-ECMO support for severe cardiocirculatory compromise. To date, there is limited literature and absence of evidence from randomized trials addressing the use of levosimendan in VA-ECMO weaning. This study may be considered a hypothesis-generating research for randomized controlled trials to confirm its findings.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Cardiothoracic and Vascular Anesthesia<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1053/j.jvca.2021.01.019" target="_blank">https://dx.doi.org/10.1053/j.jvca.2021.01.019</a></p> |
| eu_rights_str_mv | openAccess |
| id | Manara2_b6246aa0aed182659f02f5b1ad1a9d37 |
| identifier_str_mv | 10.1053/j.jvca.2021.01.019 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/24083697 |
| publishDate | 2021 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-AnalysisRasha Kaddoura (12506936)Amr S. Omar (16932537)Mohamed Izham Mohamed Ibrahim (10221287)Abdulaziz Alkhulaifi (16932540)Roberto Lorusso (5193650)Hagar Elsherbini (16932543)Osama Soliman (4539073)Kadir Caliskan (3441230)Biomedical and clinical sciencesCardiovascular medicine and haematologyClinical sciencescardiogenic shockECLSextracorporeal life supportextracorporeal membrane oxygenationlevosimendanweaning<h3>Objectives</h3><p dir="ltr">Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides a temporary support system for patients with cardiogenic shock refractory to conventional medical therapies. It has been reported that levosimendan may facilitate VA-ECMO weaning and improve survival. The primary objective of this review was to examine the effect of levosimendan use on VA-ECMO weaning and mortality in critically ill patients on VA-ECMO.</p><h3>Design</h3><p dir="ltr">MEDLINE, EMBASE, and CENTRAL were searched. A pair of reviewers identified eligible clinical trials. Two reviewers extracted data and independently assessed the risk of bias. A random-effect model was used to combine data. The primary outcome was the success of weaning from VA-ECMO.</p><h3>Measurements and Main Results</h3><p dir="ltr">Seven studies of observational design, including a total of 630 patients, were selected in the final analysis. The sample size ranged from ten-to-240 patients, with a mean age between 53 and 65 years, and more than half of them underwent cardiac surgeries. The VA-ECMO durations varied between four and 11.6 days. Overall, levosimendan use was significantly associated with successful weaning compared with control (odds ratio [OR] 2.89, 95% CI, 1.53-5.46; p<sub>overall effect</sub> = 0.001); I<sup>2</sup> = 49%). For survival, six studies (n = 617) were included in the meta-analysis involving 326 patients in the levosimendan group and 291 in the comparator group. Pooled results showed a significantly higher survival rate in the levosimendan group (OR 0.46, 95% CI, 0.30-0.71; p<sub>overall effect</sub> = 0.0004; I<sup>2</sup> = 20%).</p><h3>Conclusions</h3><p dir="ltr">Levosimendan therapy was significantly associated with successful weaning and survival benefit in patients with cardiogenic or postcardiotomy shock needing VA-ECMO support for severe cardiocirculatory compromise. To date, there is limited literature and absence of evidence from randomized trials addressing the use of levosimendan in VA-ECMO weaning. This study may be considered a hypothesis-generating research for randomized controlled trials to confirm its findings.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Cardiothoracic and Vascular Anesthesia<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1053/j.jvca.2021.01.019" target="_blank">https://dx.doi.org/10.1053/j.jvca.2021.01.019</a></p>2021-01-16T00:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1053/j.jvca.2021.01.019https://figshare.com/articles/journal_contribution/The_Effectiveness_of_Levosimendan_on_Veno-Arterial_Extracorporeal_Membrane_Oxygenation_Management_and_Outcome_A_Systematic_Review_and_Meta-Analysis/24083697CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/240836972021-01-16T00:00:00Z |
| spellingShingle | The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis Rasha Kaddoura (12506936) Biomedical and clinical sciences Cardiovascular medicine and haematology Clinical sciences cardiogenic shock ECLS extracorporeal life support extracorporeal membrane oxygenation levosimendan weaning |
| status_str | publishedVersion |
| title | The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis |
| title_full | The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis |
| title_fullStr | The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis |
| title_short | The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis |
| title_sort | The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis |
| topic | Biomedical and clinical sciences Cardiovascular medicine and haematology Clinical sciences cardiogenic shock ECLS extracorporeal life support extracorporeal membrane oxygenation levosimendan weaning |