Levosimendan in Patients with Cardiogenic Shock Refractory to Dobutamine Weaning.

Journal

American journal of cardiovascular drugs : drugs, devices, and other interventions
ISSN: 1179-187X
Titre abrégé: Am J Cardiovasc Drugs
Pays: New Zealand
ID NLM: 100967755

Informations de publication

Date de publication:
21 Oct 2024
Historique:
accepted: 11 09 2024
medline: 21 10 2024
pubmed: 21 10 2024
entrez: 21 10 2024
Statut: aheadofprint

Résumé

This study examines the effects of levosimendan in patients refractory to dobutamine weaning. This retrospective study included patients with cardiogenic shock refractory to dobutamine weaning failure admitted between 2010 and 2022. Patients treated with another type of dobutamine alone were compared with those treated with levosimendan in combination with dobutamine. Successful inotrope withdrawal was defined as survival without catecholamine support, transplant, or definitive ventricular assist device at 30 days. Secondary outcomes included all-cause mortality at 30 and 90 days. Among 349 patients with cardiogenic shock and failure to withdraw from dobutamine, levosimendan was administered in combination with dobutamine in 114 patients, and another type of dobutamine alone was administered in 235 patients. At 30 days, successful inotrope withdrawal occurred in 46 (43.4%) patients taking levosimendan plus dobutamine versus 24 (10.5%) patients in the dobutamine-only group (weighted odds ratio [OR] 4.99, 95% confidence interval [CI] 2.65-9.38; p < 0.001), with similar results at 90 days (weighted OR 6.16, 95% CI 3.22-11.78; p < 0.001). Levosimendan + dobutamine was associated with lower 30-day mortality (weighted OR 0.47, 95% CI 0.26-0.84; p = 0.01), with no difference at 90 days (weighted OR 0.67, 95% CI 0.39-1.14; p = 0.14). Adding levosimendan to dobutamine may improve inotrope withdrawal success and reduce 30-day mortality in patients with initial weaning failure.

Sections du résumé

BACKGROUND BACKGROUND
This study examines the effects of levosimendan in patients refractory to dobutamine weaning.
METHODS METHODS
This retrospective study included patients with cardiogenic shock refractory to dobutamine weaning failure admitted between 2010 and 2022. Patients treated with another type of dobutamine alone were compared with those treated with levosimendan in combination with dobutamine. Successful inotrope withdrawal was defined as survival without catecholamine support, transplant, or definitive ventricular assist device at 30 days. Secondary outcomes included all-cause mortality at 30 and 90 days.
RESULTS RESULTS
Among 349 patients with cardiogenic shock and failure to withdraw from dobutamine, levosimendan was administered in combination with dobutamine in 114 patients, and another type of dobutamine alone was administered in 235 patients. At 30 days, successful inotrope withdrawal occurred in 46 (43.4%) patients taking levosimendan plus dobutamine versus 24 (10.5%) patients in the dobutamine-only group (weighted odds ratio [OR] 4.99, 95% confidence interval [CI] 2.65-9.38; p < 0.001), with similar results at 90 days (weighted OR 6.16, 95% CI 3.22-11.78; p < 0.001). Levosimendan + dobutamine was associated with lower 30-day mortality (weighted OR 0.47, 95% CI 0.26-0.84; p = 0.01), with no difference at 90 days (weighted OR 0.67, 95% CI 0.39-1.14; p = 0.14).
CONCLUSION CONCLUSIONS
Adding levosimendan to dobutamine may improve inotrope withdrawal success and reduce 30-day mortality in patients with initial weaning failure.

Identifiants

DOI: 10.1007/s40256-024-00683-z PMID: 39432228
pubmed: 39432228
doi: 10.1007/s40256-024-00683-z
pii: 10.1007/s40256-024-00683-z
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Références

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Auteurs

Michel Zeitouni (M)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Elodie Dorvillius (E)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

David Sulman (D)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Niki Procopi (N)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Frederic Beaupré (F)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Perrine Devos (P)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Olivier Barthélémy (O)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Stéphanie Rouanet (S)

Statistician Unit, StatEthic, ACTION Study group, Levallois-Perret, France.

Arnaud Ferrante (A)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Juliette Chommeloux (J)

Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, CEDEX, Paris, France.

Guillaume Hekimian (G)

Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, CEDEX, Paris, France.

Mathieu Kerneis (M)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Johanne Silvain (J)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Gilles Montalescot (G)

ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris-Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France. gmontalescot@gmail.com.
ORCID: 0000-0003-0824-6809

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