A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery

• Published in: The New England journal of medicine Vol. 373; no. 15; pp. 1397 - 1407
• Main Authors: Meybohm, Patrick, Bein, Berthold, Brosteanu, Oana, Cremer, Jochen, Gruenewald, Matthias, Stoppe, Christian, Coburn, Mark, Schaelte, Gereon, Böning, Andreas, Niemann, Bernd, Roesner, Jan, Kletzin, Frank, Strouhal, Ulrich, Reyher, Christian, Laufenberg-Feldmann, Rita, Ferner, Marion, Brandes, Ivo F, Bauer, Martin, Stehr, Sebastian N, Kortgen, Andreas, Wittmann, Maria, Baumgarten, Georg, Meyer-Treschan, Tanja, Kienbaum, Peter, Heringlake, Matthias, Schön, Julika, Sander, Michael, Treskatsch, Sascha, Smul, Thorsten, Wolwender, Ewa, Schilling, Thomas, Fuernau, Georg, Hasenclever, Dirk, Zacharowski, Kai
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 08.10.2015
• Subjects: Aged; Anesthesia; Anesthesia, Intravenous; Calcium-binding protein; Cardiac Surgical Procedures; Cardiology; Cardiopulmonary Bypass; Cerebral infarction; Clinical outcomes; Clinical trials; Double-Blind Method; Elective Surgical Procedures; Female; Fibrillation; Heart; Heart surgery; Humans; Intravenous administration; Ischemia; Ischemic Preconditioning - methods; Kaplan-Meier Estimate; Length of Stay; Male; Mechanical ventilation; Middle Aged; Myocardial infarction; Patients; Postoperative Complications - prevention & control; Propofol; Prospective Studies; Renal failure; Reperfusion; Treatment Failure; Troponin; Troponin - blood; Upper Extremity - blood supply
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1413579

This multicenter, randomized, controlled trial involving adults undergoing elective cardiac surgery with cardiopulmonary bypass while under propofol anesthesia compared upper-limb remote ischemic preconditioning with a sham intervention. No relevant benefit was observed. Cardiac surgery is associated with a predictable risk of end-organ ischemic and reperfusion injury. Transient ischemia of nonvital tissue, known as remote ischemic preconditioning (RIPC), is reported to help remote vital organs withstand a subsequent prolonged ischemic event. 1 Although proof-of-concept trials suggested that RIPC provides protection against myocardial and kidney injury, as determined by serum cardiac and renal biomarkers, in patients undergoing cardiovascular surgery, 2 – 4 more recent studies failed to show significant differences between the RIPC and control groups with respect to troponin release, inotropic or vasoconstrictor support, renal dysfunction, and lung injury. 5 – 10 Only a few studies have included . . .