Levosimendan reduces mortality in critically ill patients. A meta-analysis of randomized controlled studies

Aim. Critically ill patients often need catecholamines, but these agents could be associated with an increased risk of death and other adverse cardiac events. Levosimendan is a calcium sensitizer that is able to enhance myocardial contractility without increasing myocardial oxygen use. We conducted a meta-analysis to determine the impact of levosimendan on mortality in critically ill patients. Methods. Four investigators independently searched BioMedCentral and PubMed to identify all randomized trials that compared levosimendan vs. control with no restriction in dose or time of administration. Exclusion criteria were duplicate publications, non-human experimental studies, and no information on the primary outcome (mortality). Results. Data from a total of 3,350 patients from 27 randomized controlled studies were included in the analysis. Levosimendan was associated with a significant reduction in mortality (333/1893 [17.6%] in the levosimendan group vs. 326/1457 [22.4%] in the control arm, OR=0.74 [0.62-0.89], P for effect=0.001) and in the rate of myocardial infarction (3/493 [0.6%] in the levosimendan group vs. 14/356 [3.9%] in the control arm P=0.007), with a significant increase in the rate of hypotension (164/1484 [11.1%] in the levosimendan group vs. 106/1093 [9.7%] in the control arm P=0.02). Conclusion. Levosimendan has cardioprotective effects that could result in a reduced mortality in critically ill patients. A large randomized controlled study is warranted in this setting. (Minerva Anestesiol 2010;76:276-86)