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

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) *…