{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T11:14:10Z","timestamp":1793445250503,"version":"4.5.0"},"reference-count":36,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"2022 Beijing Major Epidemic Prevention and Control Key Speciality Intensive Care Medical Construction Project","award":["ZDYQFZZDZK"],"award-info":[{"award-number":["ZDYQFZZDZK"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,9]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of levosimendan in promoting weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with refractory cardiogenic shock through a meta-analysis of clinical trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed, Embase, the Cochrane Library and Web of Science were systematically searched from inception to January 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Studies were included if they were clinical trials comparing outcomes between patients receiving levosimendan and those not receiving it during VA-ECMO support. Eligible studies reported on at least one of the predefined outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Two independent reviewers extracted data and assessed study quality. The primary outcome was successful VA-ECMO weaning. Secondary outcomes included 30-day mortality, in-hospital mortality, duration of ECMO support and length of stay in the intensive care unit (ICU). A random-effects model was used to synthesise data and estimate pooled effect sizes, with heterogeneity assessed using the I\u00b2 statistic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Involving 2083 patients across 16 studies, levosimendan significantly improved VA-ECMO weaning success (OR=2.44, 95% CI: 1.72 to 3.48; p&lt;0.00001; I\n                      <jats:sup>2<\/jats:sup>\n                      =57%) compared with the control group. Additionally, it notably reduced 30-day mortality (OR=0.48, 95%\u2009CI: 0.29 to 0.81; p=0.006; I\n                      <jats:sup>2<\/jats:sup>\n                      =56%) and in-hospital mortality (OR=0.47, 95%\u2009CI: 0.26 to 0.88; p=0.02; I\n                      <jats:sup>2<\/jats:sup>\n                      =70%). Noteworthy, however, is the association of levosimendan with prolonged VA-ECMO support (days; n=1314; weighted mean difference (WMD): 2.86, 95%\u2009CI: 1.73 to 4.00; p&lt;0.00001; I\n                      <jats:sup>2<\/jats:sup>\n                      =60%) and extended ICU stay (days; n=629; WMD: 5.69, 95%\u2009CI: 2.19 to 9.20; p=0.001; I\n                      <jats:sup>2<\/jats:sup>\n                      =61%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Levosimendan improves VA-ECMO weaning success and reduces mortality. Further high-quality randomised controlled trials (RCTs) are required to confirm its clinical benefits in VA-ECMO patients. While the findings consolidate existing evidence favouring levosimendan, they also highlight residual heterogeneity and moderate-to-high risk of bias in several included studies. Therefore, future investigations, particularly well-powered RCTs with robust methodology, may help further delineate its role in specific patient populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101995","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:09:09Z","timestamp":1759306149000},"page":"e101995","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical outcomes of levosimendan administration in veno-arterial extracorporeal membrane oxygenation: a meta-analysis"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct04158674","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04728932","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Guo-min","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Emergency and Critical Care Medical Centre, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Clinical and Research Centre on Acute Lung Injury, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo-mei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Emergency and Critical Care Medical Centre, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Clinical and Research Centre on Acute Lung Injury, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Emergency and Critical Care Medical Centre, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Clinical and Research Centre on Acute Lung Injury, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1559-7554","authenticated-orcid":false,"given":"Jian-Xin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Emergency and Critical Care Medical Centre, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Clinical and Research Centre on Acute Lung Injury, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9658-2969","authenticated-orcid":false,"given":"Hong-liang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Emergency and Critical Care Medical Centre, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"},{"name":"Clinical and Research Centre on Acute Lung Injury, Beijing Shijitan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"2025100101002328000_15.9.e101995.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.03.046"},{"key":"2025100101002328000_15.9.e101995.2","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/MAT.0000000000000771","article-title":"Cannula-Related Infection in Patients Supported by Peripheral ECMO: Clinical and Microbiological Characteristics","volume":"65","author":"Allou","year":"2019","journal-title":"ASAIO J"},{"key":"2025100101002328000_15.9.e101995.3","doi-asserted-by":"crossref","unstructured":"Aubron C , DePuydt J , Belon F , et al . 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