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Effect of selenium on early outcomes after cardiopulmonary resuscitation

A preliminary report from a retrospective data evaluation
  • K. FinkEmail author
  • H.-J. Busch
Originalien
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Abstract

Background

Administration of selenium, a trace element with antioxidative properties, has been shown to be beneficial in critically ill patients.

Objective

In this retrospective study, we analyzed the influence of selenium treatment on the outcome of patients after cardiopulmonary resuscitation (CPR) following cardiac arrest.

Patients and methods

We retrospectively analyzed selenium plasma levels, neurological performance by Cerebral Performance Categories (CPC), and survival to discharge of 28 resuscitated patients receiving selenium treatment of any cause 24, 48, or 72 h after CPR. All patients received a 1000 µg selenium bolus, followed by a 1000 µg continuous intravenous infusion during a 24 h period. Results were compared to matched controls of resuscitated patients without selenium administration within the first 72 h after CPR.

Results

There were clearly distinct time courses of selenium plasma levels between the selenium and the control groups, and between the selenium groups depending on the timepoint of selenium administration after cardiac arrest. Patients receiving selenium within the first 48 h—and especially those with selenium administration within the first 24 h after CPR—showed significantly better neurological outcome, reflected by CPC, and significantly higher survival compared to controls.

Conclusion

This small observational study gives an indication of a possible improvement in neurological outcome and survival rate with early selenium treatment in patients after CPR.

Keywords

Cardiac arrest Survival Ischemia, reperfusion injury Antioxidative treatment Postresuscitation care 

Effekt von Selen in der frühen Phase der Postreanimationsbehandlung

Erste Ergebnisse einer retrospektiven Datenanalyse

Zusammenfassung

Hintergrund

Die Substitution von Selen, einem Spurenelement mit antioxidativen Eigenschaften, scheint für kritisch kranke Patienten von Vorteil zu sein.

Ziel der Arbeit

In der vorliegenden retrospektiven Datenanalyse untersuchten wir den Einfluss einer Selensubstitution auf das Überleben und das neurologische Ergebnis bei Patienten nach kardiopulmonaler Reanimation (CPR) bei Herz-Kreislauf-Stillstand.

Patienten und Methoden

Retrospektive Analyse der Selenplasmaspiegel, Cerebral Performance Categories (CPC) und des Überlebens bis zur Entlassung von der Intensivstation bei 28 reanimierten Patienten, die innerhalb der ersten 24, 48 oder 72 h nach CPR aus jedwedem Grund Selen erhalten hatten. Alle Patienten erhielten einen Bolus von 1000 μg Selen, gefolgt von einer kontinuierlichen Infusion von weiteren 1000 μg über 24 h. Die Ergebnisse wurden mittels Matched-pair-Analyse mit reanimierten Patienten, die innerhalb der ersten 72 h nach CPR kein Selen erhalten hatten, verglichen.

Ergebnisse

Im Zeitverlauf der Selenplasmaspiegel fanden sich deutliche Unterschiede zwischen der Selen- und Kontrollgruppe. Gleiches gilt für die einzelnen Selenuntergruppen in Abhängigkeit vom Zeitpunkt der Selengabe im Postreanimationsverlauf. Patienten, die innerhalb der ersten 48 h nach CPR Selen erhalten hatten, insbesondere die mit Selenapplikation innerhalb der ersten 24 h, überlebten im Vergleich zur Kontrollgruppe häufiger und hatten gemäß den CPC weniger neurologische Defizite.

Schlussfolgerung

Die vorliegende kleine Observationsstudie zeigt einen möglichen Nutzen einer frühen Selengabe bei Patienten nach CPR in Bezug auf das neurologische Ergebnis und das Überleben.

Schlüsselwörter

Herz-Kreislauf-Stillstand Überleben Ischämie-Reperfusions-Schäden Antioxidative Therapie Postreanimationsbehandlung 

Notes

Acknowledgements

The authors thank Monica Moebes, Natascha Bourgeois, and the staff of the medical intensive care units of the University Hospital Freiburg for their help in sample and data collection.

Compliance with ethical guidelines

Conflict of interest

K. Fink and H.-J. Busch declare that they have no competing interests.

The study was approved by the ethics committee of the University Medical Center Freiburg (approval number 328/09) in advance and conforms to the declaration of Helsinki. Informed consent was obtained post hoc from patients surviving with good neurological outcome or from their relatives in case of non-surviving patients. The trial was retrospectively registered in the German Clinical Trials Register (DRKS00011493) on 12/01/2017.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Medical Center—University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburg im BreisgauGermany

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