Effects of Levosimendan on Endothelial Function and Hemodynamics During Weaning from Veno-Arterial Extracorporeal Life Support
Articolo
Data di Pubblicazione:
2016
Citazione:
Effects of Levosimendan on Endothelial Function and Hemodynamics During Weaning from Veno-Arterial Extracorporeal Life Support / F. Sangalli, L. Avalli, M. Laratta, F. Formica, E. Maggioni, R. Caruso, M.C. Costa, M. Guazzi, R. Fumagalli. - In: JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA. - ISSN 1053-0770. - 30:6(2016), pp. 1449-1453. [10.1053/j.jvca.2016.03.139]
Abstract:
Objective
Weaning 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.
Design
This was a prospective observational trial.
Setting
Cardiovascular intensive care unit of a large tertiary care university hospital in Monza, Italy.
Participants and Interventions
Flow-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 Results
Flow-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).
Conclusion
In 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.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
cardiogenic shock; ECMO; extracorporeal life support; endothelial function; levosimendan; hemodynamics
Elenco autori:
F. Sangalli, L. Avalli, M. Laratta, F. Formica, E. Maggioni, R. Caruso, M.C. Costa, M. Guazzi, R. Fumagalli
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