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

Who May Qualify: 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); Who Should NOT Join This Trial: - 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) Always talk to your doctor about whether this trial is right for you.