Effect of Levosimendan Use on All-Cause Mortality in Out-of-Hospital Cardiac Arrest Survivors After Extracorporeal Cardiopulmonary Resuscitation

Background: Out-of-hospital cardiac arrest (OHCA) survivors after extracorporeal cardiopulmonary resuscitation (ECPR) have a 50-70% mortality rate. However, the use of vasoactive inotropes during the first 24 h worsened the mortality rate. Be-cause of administering inodilators (e.g., levosimendan and milrinone) within 72 h of ECPR could facilitate extracorporeal membrane oxygenation (ECMO) weaning, it is crucial to determine whether the use of inodilators could im-prove mortality rates. Methods: This retrospective cohort study included 158 patients with OHCA of cardiac origin who had undergone ECPR and were hospitalized between January 2015 and December 2024. This study was con-ducted in the intensive care unit of China Medical University Hospital, Tai-chung, Taiwan. Twenty-three patients received levosimendan within 72 h, whereas the others did not receive an inodilator. Primary endpoints included ECMO weaning failure and the 90-day all-cause mortality rate. Kaplan-Meier survival curve analysis was also performed. Possible covariates for all-cause mortality were estimated using Cox regression modeling. Results The levosi-mendan group exhibited lower rates of ECMO weaning failure and 90-day all-cause mortality than the control group (13.0% vs. 52.6% and 17.4% vs. 57.0%, respectively; both p < 0.001). The 90-day survival curve analysis re-vealed that the levosimendan and control groups had survival rates of 0.83 and 0.43, respectively (log-rank p < 0.001). Administration of levosimendan within 72 h resulted in a hazard ratio of 0.30 (95% confidence interval: 0.12−0.75, p = 0.01). Conclusions Administering levosimendan within 72 h of ECPR could be a protective factor in improving all-cause mortality.