• Fabio Sangalli, Leonello Avalli, Matteo Laratta, Francesco Formica, Elena Maggioni, Rosa Caruso, Cristina Costa Maria M Clinical Perfusion Service, San Gerardo Hospital, Monza, Italy., Marco Guazzi, and Roberto Fumagalli.
• Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy. Electronic address: f.sangalli@hsgerardo.org.
• J. Cardiothorac. Vasc. Anesth. 2016 Dec 1; 30 (6): 1449-1453.

ObjectiveWeaning from veno-arterial extracorporeal life support is challenging. The objective of this trial was to investigate the endothelial and hemodynamic effects of levosimendan in cardiogenic shock patients supported with veno-arterial extracorporeal life support.DesignThis was a prospective observational trial.SettingCardiovascular intensive care unit of a large tertiary care university hospital in Monza, Italy.Participants And InterventionsFlow-mediated dilatation of the brachial artery and hemodynamic parameters were assessed in 10 cardiogenic shock patients supported with veno-arterial extracorporeal life support, before and after the infusion of levosimendan.Measurements And ResultsFlow-mediated dilatation increased both as absolute value and as a percentage after levosimendan, from 0.10±0.12 to 0.61±0.21 mm (p<0.001) and from 3.2±4.2% to 17.8±10.4% (p<0.001), respectively. Cardiac index increased from 1.93±0.83 to 2.64±0.97 L/min/m2 (p = 0.008) while mixed venous oxygen saturation increased from 66.0% to 71.5% (p = 0.006) and arterial lactate levels decreased from 1.25 to 1.05 mmol/L (p = 0.004) without significant variations in arterial oxygen saturation or hemoglobin levels. This made it possible for clinicians to reduce extracorporeal membrane oxygenation blood flow from 1.92±0.65 to 1.12±0.49 L/min/m2 (p<0.001).ConclusionIn conclusion, in the authors' study population of adult cardiogenic shock patients supported with veno-arterial extracorporeal life support, their observations supported the use of levosimendan to improve endothelial function and hemodynamics and facilitate weaning from the extracorporeal support.Copyright © 2016 Elsevier Inc. All rights reserved.

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