Utilization of Levosimendan in Critically Ill Patients With Cardiogenic Shock Requiring Catecholamines

Abstract

Background: Levosimendan, a novel inodilator, has been shown to improve hemodynamic function in patients with decompensated heart failure. Data on its use in patients with shock are rare. The present series describes the effects of levosimendan as add-on therapy in desperately ill patients with cardiogenic shock requiring catecholamines. This was a cohort retrospective study for patients with cardiogenic shock requiring catecholamines. Methods: Six patients with cardiogenic shock received levosimendan as continuous infusion of 0.1 μg/kg−1/min−1 for 24 hours. The patients were otherwise unselected. Hemodynamic measurements were routinely performed at baseline (time 0) and at 48 hours after start of levosimendan (LS) using a Swan-Ganz thermodilution catheter in 4 patients. Results: During the levosimendan infusion, there was a nonsignificant improvement in hemodynamic variables. Changes in catecholamine dose and in systolic and diastolic blood pressure were not significant. There was only one death during hospitalization and a significant decrease of mechanical ventilation support after 48 hours (P = 0.02). Conclusions: This series shows that a LS infusion is feasible and possibly able to improve hemodynamics in severely compromised, critically ill patients with cardiogenic shock requiring catecholamine therapy. To clarify the potential role of LS in this clinical setting, randomized, controlled trials on hemodynamic and mortality end points are needed.TABLE