Levosimendan use in extracorporeal cardiopulmonary resuscitation (ECPR) did not improve survival. Neurological outcome could be representative of the short- and long-term outcomes.

Future well-designed randomized trials are warranted to investigate the potential benefit of levosimendan in the ECPR setting.

This study has limitations that should be acknowledged.

It is of a retrospective nonrandomized design that was conducted in a single center with a limited number of patients. Thus, the neutral results may have reflected the limited study power to detect a meaningful difference between the comparators.

We recruited patients who experienced cardiac arrest either in or out hospital and we believe that these are distinct patient groups in terms of enrollment and outcomes.

Propensity score matching was not performed, which might have decreased recruitment bias.

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