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

J Crit Care. 2024 Oct:83:154853. doi: 10.1016/j.jcrc.2024.154853. Epub 2024 Jul 2.

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.

Keywords: Antioxidants; Cardiac surgery; Inflammation; Mechanical circulatory support; Post-cardiotomy cardiogenic shock.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Cardiac Surgical Procedures*
  • Female
  • Heart-Assist Devices
  • Humans
  • Male
  • Middle Aged
  • Multiple Organ Failure / etiology
  • Multiple Organ Failure / mortality
  • Multiple Organ Failure / prevention & control
  • Postoperative Complications* / mortality
  • Postoperative Complications* / prevention & control
  • Selenium* / administration & dosage
  • Selenium* / therapeutic use
  • Shock, Cardiogenic* / mortality
  • Shock, Cardiogenic* / therapy

Substances

  • Selenium