{"id":29726,"date":"2026-02-02T04:16:00","date_gmt":"2026-02-01T20:16:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29726"},"modified":"2026-02-02T05:35:46","modified_gmt":"2026-02-01T21:35:46","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e4%b8%a5%e9%87%8d%e5%bf%83%e6%ba%90%e6%80%a7%e4%bc%91%e5%85%8b%e6%82%a3%e8%80%85%e4%bd%bf%e7%94%a8%e5%b7%a6%e8%a5%bf%e5%ad%9f%e6%97%a6%e8%84%b1","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29726","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u4e25\u91cd\u5fc3\u6e90\u6027\u4f11\u514b\u60a3\u8005\u4f7f\u7528\u5de6\u897f\u5b5f\u65e6\u8131\u79bbECMO"},"content":{"rendered":"\n

Original Investigation<\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

Levosimendan to Facilitate Weaning From ECMO in Patients With Severe Cardiogenic Shock: The LEVOECMO Randomized Clinical Trial<\/h1>\n\n\n\n

Alain Combes, Ouriel Saura, Nicolas Nesseler, et al<\/h3>\n\n\n\n

JAMA Published Online: December 1, 2025<\/h3>\n\n\n\n

doi: 10.1001\/jama.2025.19843<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  In patients with severe but potentially reversible cardiogenic shock who are receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO), does early administration of levosimendan improve time to successful ECMO weaning within 30 days following randomization?<\/p>\n\n\n\n

Findings<\/strong>  In this double-blind, placebo-controlled randomized clinical trial that included 205 patients receiving VA-ECMO, successful ECMO weaning at day 30 occurred in 69 (68.3%) in the levosimendan group compared with 71 (68.3%) in the placebo group, a nonsignificant difference.<\/p>\n\n\n\n

Meaning<\/strong>  In patients with potentially reversible cardiogenic shock supported by VA-ECMO, levosimendan did not reduce the time to successful weaning from ECMO compared with placebo.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Levosimendan may facilitate weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) and improve survival, but supporting evidence remains limited.<\/p>\n\n\n\n

Objective<\/strong>  To assess whether early administration of levosimendan reduces the time to successful VA-ECMO weaning in patients with severe but potentially reversible cardiogenic shock.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  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.<\/p>\n\n\n\n

Interventions<\/strong>  Patients were randomized in a 1:1 ratio to receive levosimendan, 0.15 \u03bcg\/kg per minute, to be increased to 0.20 \u03bcg\/kg per minute after 2 hours (n\u2009=\u2009101), or placebo (n\u2009=\u2009104).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was time to successful ECMO weaning within 30 days following randomization. Secondary outcomes included ECMO-, mechanical ventilation\u2013, and organ failure\u2013free days, ICU and hospital lengths of stay, serious adverse events, and all-cause 30- and 60-day mortality.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 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 \u00b1 0.01 \u03bcg\/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, \u221212.8% to 12.7%]; subdistribution hazard ratio, 1.02 [95% CI, 0.74-1.39];\u00a0P<\/em>\u2009=\u2009.92). In the levosimendan and placebo groups, respectively, median ECMO duration (5 [IQR, 4-7] days vs 6 [IQR, 4-11] days;\u00a0P<\/em>\u2009=\u2009.53), mean ICU length of stay (18 [SD, 15] days vs 19 [SD, 15] days;\u00a0P<\/em>\u2009=\u2009.42), and 60-day mortality (27.7% vs 25.0%; risk difference, 2.7% [95% CI, \u22129.0% to 15.3%];\u00a0P<\/em>\u2009=\u2009.78) 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%]).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  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.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT04728932<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation Caring for the Critically Ill Pa […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29726"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29726"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29726\/revisions"}],"predecessor-version":[{"id":29936,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29726\/revisions\/29936"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29726"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29726"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29726"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}