Levosimendan to Facilitate Weaning From ECMO in Patients With Severe Cardiogenic Shock: The LEVOECMO Randomized Clinical Trial.

Summary

In a multicenter double-blind RCT (n=205), levosimendan did not shorten time to successful VA-ECMO weaning within 30 days versus placebo and did not improve ECMO duration, ICU stay, or 60-day mortality. Ventricular arrhythmias were more frequent with levosimendan.

Key Findings

• No difference in 30-day successful VA-ECMO weaning (68.3% vs 68.3%; sHR 1.02, P=0.92).
• No significant differences in ECMO duration, ICU length of stay, or 60-day mortality.
• Higher ventricular arrhythmias with levosimendan (17.8% vs 8.7%).

Clinical Implications

Avoid routine levosimendan for VA-ECMO weaning; consider arrhythmia risk. Resource allocation and protocols should not include levosimendan for this indication outside trials.

Limitations

• Single-country study; generalizability may be limited.
• Sample may be underpowered for mortality differences; heterogeneous etiologies of shock.

Future Directions

Targeted trials in specific cardiogenic shock phenotypes, timing strategies (pre-weaning vs peri-decannulation), and comparative inotrope studies with arrhythmia monitoring.