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The effect of high-dose selenium on mortality and postoperative organ dysfunction in post-cardiotomy cardiogenic shock patients supported with mechanical circulatory support - A post-hoc analysis of the SUSTAIN CSX trial

Ott S 1 , Dresen E 2 , Lee ZY 3 , Müller-Wirtz LM 4 , Procopiuc L 5 , Ekrami E 6 Show all authors , Pitts L 7 , Hellner N 8 , Catena D 9 , Duerr GD 10 , Wittmann M 11 , Waeschle RM 12 , Elke G 13 , O'Brien B 14 , Heyland DK 15 , Stoppe C 16

Affiliations 

  • 1 Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, OH, USA. Electronic address: Sascha.ott@dhzc-charite.de
  • 2 University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany. Electronic address: Dresen_E@ukw.de
  • 3 Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Anaesthesiology, Faculty of Medicine, University of Malaysia, Kuala Lumpur, Malaysia
  • 4 Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, OH, USA; Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, 66424 Homburg, Saarland, Germany. Electronic address: lukas@muellerwirtz.de
  • 5 Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. Electronic address: livia.procopiuc@dhzc-charite.de
  • 6 Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, OH, USA. Electronic address: ekramie@ccf.org
  • 7 Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany; Berlin Institute of Health, 10117 Berlin, Germany. Electronic address: Leonard.pitts@dhzc-charite.de
  • 8 Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. Electronic address: nicolas.hellner@charite.de
  • 9 Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. Electronic address: Daniel.catena@charite.de
  • 10 Department of Cardiovascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
  • 11 Department of Anaesthesiology, University Hospital Bonn, Bonn, Germany. Electronic address: Maria.Wittmann@ukbonn.de
  • 12 Department of Anaesthesiology, University Medical Center Göttingen, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany. Electronic address: rwaeschle@med.uni-goettingen.de
  • 13 Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany. Electronic address: gunnar.elke@uksh.de
  • 14 Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; St Bartholomew's Hospital and Barts Heart Centre, Department of Perioperative Medicine, London, EC1A 7BE, UK. Electronic address: Ben.obrien@dhzc-charite.de
  • 15 Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. Electronic address: dkh2@queensu.ca
  • 16 Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany. Electronic address: Stoppe_c@ukw.de
J Crit Care, 2024 Oct;83:154853.
PMID: 38955117 DOI: 10.1016/j.jcrc.2024.154853

Abstract

PURPOSE: Cardiac surgery, post-cardiotomy cardiogenic shock (PCCS), and temporary mechanical circulatory support (tMCS) provoke substantial inflammation. We therefore investigated whether a selenium-based, anti-inflammatory strategy would benefit PCCS patients treated with tMCS in a post-hoc analysis of the sustain CSX trial.

METHODS: Post-hoc analysis of patients receiving tMCS for PCCS in the Sustain CSX trial, which investigated the effects of high-dose selenium on postoperative organ dysfunction in cardiac surgery patients.

PRIMARY OUTCOME: duration of tMCS therapy.

SECONDARY OUTCOMES: postoperative organ dysfunction and 30-day mortality.

RESULTS: Thirty-nine patients were treated with tMCS for PCCS. There was no difference in the median duration of tMCS between the selenium and the placebo group (3 days [IQR: 1-6] vs. 2 days [IQR: 1-7], p = 0.52). Median dialysis duration was longer in the selenium group (1.5 days [0-21.8] vs. 0 days [0-1.8], p = 0.048). There was no difference in 30-day mortality (53% vs. 41%, OR 1.44, 95% CI 0.32-6.47, p = 0.62).

CONCLUSION: In this explorative study, a perioperative high-dose selenium-supplementation did not show beneficial effects on organ dysfunctions and mortality rates in patients with PCCS receiving tMCS.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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