Effect of Early Use of Levosimendan Versus Placebo on Top of a Conventional Strategy of Inotrope Use on a Combined Morbidity-mortality Endpoint in Patients With Cardiogenic Shock
Recruiting · NCT04020263 · Interventional (participants receive a specific treatment) · Lead sponsor: Pr Bruno LEVY
View the official record on ClinicalTrials.gov →Interventions studied
What this trial is about
Cardiogenic shock (CS) mortality remains high (40%). Despite their frequent use, few clinical outcome data are available to guide the initial selection of vasoactive drug therapies in patients with CS. Based on experts' opinions, the combination of norepinephrine-dobutamine is generally recommended as a first line strategy. Inotropic agents increase myocardial contractility, thereby increasing cardiac output. Dobutamine is commonly recommended to be the inotropic agent of choice and levosimendan is generally used following dobutamine failure. It may represent an ideal agent in cardiogenic shock, since it improves myocardial contractility without increasing cAMP or calcium concentration. At present, there are no convincing data to support a specific inotropic agent in patients with cardiogenic shock. Our hypothesis is that the early use of levosimendan, by enabling the discontinuation of dobutamine, would accelerate the resolution of signs of low cardiac output and facilitate myocardial recovery.
Who can take part
Inclusion criteria
- Adult patient ≥ 18 years with cardiogenic shock defined by:
- Adequate intravascular volume
- Norepinephrine to maintain MAP at least at 65 mmHg for at least 3 hours and less than 24h. At inclusion the dose must be \<1 microgram/kg/min under norepinephrine base or \<2 microgram/kg/min under norepinephrine tartrate, OR/AND Dobutamine since at least 3h and less than 24h at inclusion.
- Tissue hypoperfusion: at least 1 sign within 24h prior to inclusion (lactate ≥ 2 mmol/l; mottling, capillary refeel time \> 3 seconds, oliguria \<500ml/24h or ≤ 20 ml/h during the last 2 hours, ScVO2 ≤ 60% or veno-arterial PCO2 gap ≥ 5 mmHg);
Exclusion criteria
- Myocardial sideration after cardiac arrest of non-cardiac etiology
- Immediate or anticipated (within 6 hours) indication of Extra Corporel Life Support
- Use of VA-ECMO or IMPELLA or LVAD;
- Chronic renal failure requiring hemodialysis
- Cardiotoxic poisoning
- Septic cardiomyopathy
- Previous levosimendan administration within 15 days
- Cardiac arrest with non-shockable rhythm;
- No flow time higher \> 3 minutes;
- Cardiac arrest with unknown no flow duration;
- Total duration of cardiac arrest (no flow plus low flow) \> 45 minutes;
- Cerebral deficit with fixed dilated pupils
- Patient moribund on the day of enrollment
- Irreversible neurological pathology
- Known hypersensitivity to levosimendan or placebo, or one of its excipients
- Pregnant woman, birthing or breastfeeding mother
- Minor (not emancipated)
- Person deprived of liberty for judicial or administrative decision;
- Adult subject to a legal protection measure (such as guardianship, conservatorship)
Where it is running
28 locations listed.
- CHU Bordeaux - Bordeaux, France
- HENRI MONDOR -réanimation - Créteil, France
- Chu Dijon - Dijon, France
- CHU Grenoble -USIC - La Tronche, France
- AP-HM CHU la Timone - Marseille, France
- CHU Montpellier -hôpital Arnaud de Villeneuve - Montpellier, France
- Chu Rouen - Rouen, France
- HU Strasbourg USIC - Strasbourg, France
- CHRU Nancy - Vandœuvre-lès-Nancy, France
- CHRU Strasbourg -Nouvel Hôpital Civil - Strasbourg, Bas-Rhin, France
- AP-HM, Nord Hospital, Marseille - Marseille, Bouches du Rhône, France
- CHU Caen - Caen, Calvados, France
- CHU Dijon - Dijon, Côte d'Or, France
- CHU Besançon Jean Minjoz Hospital - Besançon, Doubs, France
- CHU Nîmes, Carémeau Hospital - Nîmes, Gard, France
- CHU Bordeaux - Hopital haut-leveque - Bordeaux, Gironde, France
- CHU de Toulouse - Toulouse, Haute-Garonne, France
- CHU Limoges, Dupuytren Hospital - Limoges, Haute-Vienne, France
- CHU Montpellier, Arnaud de Villeneuve Hospital - Montpellier, Hérault, France
- CHU Rennes, Pontchaillou Hospital - Rennes, Ille et Vilaine, France
- CHU Grenoble, Michallon Hospital - La Tronche, Isère, France
- CHU Nantes - Nantes, Loire-Atlantique, France
- CHR Metz-Thionville, Mercy Hospital - Ars-Laquenexy, Moselle, France
- CHRU Lille, Cœur Poumon Institute - Lille, Nord, France
- APHP, La Pitié Salpêtrière (medical intensive care unit) - Paris, Paris, France
- Hospices Civils de Lyon - Louis Pradel Hospital - Bron, Rhône, France
- APHP, Henri Mondor Hospital - Créteil, Val de Marne, France
- CH Henri Duffaut, Avignon - Avignon, Vaucluse, France