# LEVOECMO: levosimendan bij ECMO-weaning bij cardiogene shock

*geplaatst 2026-01-06 · Algemeen · JAMA · doi 10.1001/jama.2025.19843 · https://hartvaat.nl/2026/01/06/levoecmo-levosimendan-bij-ecmo-weaning-bij-cardiogene-shock/*

De LEVOECMO-trial onderzocht of levosimendan het ECMO-weaning-succes bij cardiogene shock verbetert. De resultaten informeren het farmacologische management bij mechanisch ondersteunde patiënten.

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

The LEVOECMO trial investigated whether levosimendan facilitates ECMO weaning in patients with severe cardiogenic shock, testing this inotropic agent as a bridge strategy to device separation.

## Abstract (original, from the publication)

IMPORTANCE: Levosimendan may facilitate weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) and improve survival, but supporting evidence remains limited. OBJECTIVE: To assess whether early administration of levosimendan reduces the time to successful VA-ECMO weaning in patients with severe but potentially reversible cardiogenic shock. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial conducted across 11 intensive care units (ICUs) in France. Between August 27, 2021, and September 10, 2024, 205 adult patients with acute cardiogenic shock who had started VA-ECMO in the preceding 48 hours were enrolled. Final follow-up was completed on November 10, 2024. INTERVENTIONS: Patients were randomized in a 1:1 ratio to receive levosimendan, 0.15 μg/kg per minute, to be increased to 0.20 μg/kg per minute after 2 hours (n = 101), or placebo (n = 104). MAIN OUTCOMES AND MEASURES: The primary outcome was time to successful ECMO weaning within 30 days following randomization. Secondary outcomes included ECMO-, mechanical ventilation-, and organ failure-free days, ICU and hospital lengths of stay, serious adverse events, and all-cause 30- and 60-day mortality. RESULTS: Among the 205 randomized patients (median age, 58 [IQR, 50-67] years; 149 [72.7%] male), main cardiogenic shock etiologies were postcardiotomy (79 [38.5%]), acute myocardial infarction (56 [27.3%]), and myocarditis (28 [13.7%]). Treatment dose was increased to 0.20 ± 0.01 μg/kg per minute in 93% of patients receiving levosimendan and in 96% of those receiving placebo. Within 30 days, 69 of 101 patients (68.3%) had a successful ECMO weaning in the levosimendan group compared with 71 of 104 (68.3%) in the placebo group (risk difference, 0.0% [95% CI, -12.8% to 12.7%]; subdistribution hazard ratio, 1.02 [95% CI, 0.74-1.39]; P = .92). In the levosimendan and placebo groups, respectively, median ECMO duration (5 [IQR, 4-7] days vs 6 [IQR, 4-11] days; P = .53), mean ICU length of stay (18 [SD, 15] days vs 19 [SD, 15] days; P = .42), and 60-day mortality (27.7% vs 25.0%; risk difference, 2.7% [95% CI, -9.0% to 15.3%]; P = .78) did not differ significantly. Ventricular arrhythmias occurred more frequently with levosimendan (18 [17.8%] vs 9 [8.7%]; absolute risk difference, 9.2% [95% CI, 0.4%-18.1%]). CONCLUSIONS AND RELEVANCE: Among patients with severe but potentially reversible cardiogenic shock supported by VA-ECMO, early levosimendan administration did not significantly reduce the time to successful weaning of ECMO compared with placebo. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04728932.

Auteurs: Alain Combes, Ouriel Saura, Nicolas Nesseler, Said Lebbah, Bertrand Rozec, Bruno Levy, Jean-Luc Fellahi, Antoine Beurton, Simon Meslin, Philippe Gaudard, Adrien Bouglé, André Vincentelli, Romain Sonneville, Guillaume Lebreton, David Lévy, Alexandre Ouattara, Florence Tubach

---
Bron: JAMA, https://doi.org/10.1001/jama.2025.19843. Bijgewerkt 2026-07-03T13:31:05Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.