PURPOSE: To assess the benefits and harms of levosimendan for low cardiac output syndrome in critically ill patients. METHODS: We conducted a systematic review with meta-analyses and trial sequential analyses (TSA) of randomised clinical trials comparing levosimendan with any type of control. Two reviewers independently assessed studies for inclusion. The Cochrane Collaboration methodology was used. Random-effects risk ratios (RR) and 95 % confidence intervals (CI) were derived for the principal primary outcome mortality at maximal follow-up. RESULTS: A total of 88 trials were included in the systematic review and 49 trials (6,688 patients) in the meta-analysis. One trial had low risk of bias and nine trials (2,490 patients) were considered lower risk of bias. Trials compared levosimendan with placebo, control interventions, and other inotropes. Pooling all trials including heterogenous populations was considered inappropriate. Pooled analysis of 30 trials including critically ill patients not having cardiac surgery showed an association between levosimendan and mortality (RR 0.83, TSA-adjusted 95 % CI 0.59-0.97), while trials with lower risk of bias showed no significant difference (RR 0.83, TSA-adjusted 95 % CI 0.48-1.55). Conventional meta-analysis of all 14 trials including cardiac surgery patients showed an association, while lower risk of bias trials showed no association between levosimendan and mortality (RR 0.52, 95 % CI 0.37-0.73 versus RR 1.02, 95 % CI 0.48-2.16). CONCLUSIONS: The available evidence is inconclusive whether or not levosimendan may have a beneficial effect on mortality due to risks of systematic errors and random errors. Further well-designed randomised trials are needed.
PURPOSE: To assess the benefits and harms of levosimendan for low cardiac output syndrome in critically illpatients. METHODS: We conducted a systematic review with meta-analyses and trial sequential analyses (TSA) of randomised clinical trials comparing levosimendan with any type of control. Two reviewers independently assessed studies for inclusion. The Cochrane Collaboration methodology was used. Random-effects risk ratios (RR) and 95 % confidence intervals (CI) were derived for the principal primary outcome mortality at maximal follow-up. RESULTS: A total of 88 trials were included in the systematic review and 49 trials (6,688 patients) in the meta-analysis. One trial had low risk of bias and nine trials (2,490 patients) were considered lower risk of bias. Trials compared levosimendan with placebo, control interventions, and other inotropes. Pooling all trials including heterogenous populations was considered inappropriate. Pooled analysis of 30 trials including critically illpatients not having cardiac surgery showed an association between levosimendan and mortality (RR 0.83, TSA-adjusted 95 % CI 0.59-0.97), while trials with lower risk of bias showed no significant difference (RR 0.83, TSA-adjusted 95 % CI 0.48-1.55). Conventional meta-analysis of all 14 trials including cardiac surgery patients showed an association, while lower risk of bias trials showed no association between levosimendan and mortality (RR 0.52, 95 % CI 0.37-0.73 versus RR 1.02, 95 % CI 0.48-2.16). CONCLUSIONS: The available evidence is inconclusive whether or not levosimendan may have a beneficial effect on mortality due to risks of systematic errors and random errors. Further well-designed randomised trials are needed.
Authors: Frederik Keus; Jørn Wetterslev; Christian Gluud; Cornelis J H M van Laarhoven Journal: BMC Med Res Methodol Date: 2010-10-01 Impact factor: 4.615
Authors: F Follath; J G F Cleland; H Just; J G Y Papp; H Scholz; K Peuhkurinen; V P Harjola; V Mitrovic; M Abdalla; E-P Sandell; L Lehtonen Journal: Lancet Date: 2002-07-20 Impact factor: 79.321
Authors: Milton Packer; Wilson Colucci; Lloyd Fisher; Barry M Massie; John R Teerlink; James Young; Robert J Padley; Roopal Thakkar; Leticia Delgado-Herrera; Jeffrey Salon; Chris Garratt; Bidan Huang; Toni Sarapohja Journal: JACC Heart Fail Date: 2013-04-01 Impact factor: 12.035
Authors: An-Wen Chan; Jennifer M Tetzlaff; Douglas G Altman; Andreas Laupacis; Peter C Gøtzsche; Karmela Krleža-Jerić; Asbjørn Hróbjartsson; Howard Mann; Kay Dickersin; Jesse A Berlin; Caroline J Doré; Wendy R Parulekar; William S M Summerskill; Trish Groves; Kenneth F Schulz; Harold C Sox; Frank W Rockhold; Drummond Rennie; David Moher Journal: Ann Intern Med Date: 2013-02-05 Impact factor: 25.391
Authors: Kristian Thorlund; Georgina Imberger; Michael Walsh; Rong Chu; Christian Gluud; Jørn Wetterslev; Gordon Guyatt; Philip J Devereaux; Lehana Thabane Journal: PLoS One Date: 2011-10-18 Impact factor: 3.240
Authors: K Distelmaier; C Roth; L Schrutka; C Binder; B Steinlechner; G Heinz; I M Lang; G Maurer; H Koinig; A Niessner; M Hülsmann; W Speidl; G Goliasch Journal: Br J Anaesth Date: 2016-07 Impact factor: 9.166
Authors: Anders Perner; Anthony C Gordon; Daniel De Backer; George Dimopoulos; James A Russell; Jeffrey Lipman; Jens-Ulrik Jensen; John Myburgh; Mervyn Singer; Rinaldo Bellomo; Timothy Walsh Journal: Intensive Care Med Date: 2016-10-01 Impact factor: 17.440
Authors: Julia Schumann; Eva C Henrich; Hellen Strobl; Roland Prondzinsky; Sophie Weiche; Holger Thiele; Karl Werdan; Stefan Frantz; Susanne Unverzagt Journal: Cochrane Database Syst Rev Date: 2018-01-29