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A pilot study investigating the effects of remote ischemic preconditioning in high-risk cardiac surgery using a randomised controlled double-blind protocol

  • Paul Jeffrey Young
  • Paul Dalley
  • Alexander Garden
  • Christopher Horrocks
  • Anne La Flamme
  • Barry Mahon
  • John Miller
  • Janine Pilcher
  • Mark Weatherall
  • Jenni Williams
  • William Young
  • Richard Beasley
Original Contribution

Abstract

The efficacy of remote ischemic preconditioning (RIPC) in high-risk cardiac surgery is uncertain. In this study, 96 adults undergoing high-risk cardiac surgery were randomised to RIPC (3 cycles of 5 min of upper-limb ischemia induced by inflating a blood pressure cuff to 200 mmHg with 5 min of reperfusion) or control. Main endpoints were plasma high-sensitivity troponin T (hsTNT) levels at 6 and 12 h, worst post-operative acute kidney injury (AKI) based on RIFLE criteria, and noradrenaline duration. hsTNT levels were log-normally distributed and higher with RIPC than control at 6-h post cross-clamp removal [810 ng/ml (IQR 527–1,724) vs. 634 ng/ml (429–1,012); ratio of means 1.41 (99.17% CI 0.92–2.17); P=0.04] and 12 h [742 ng/ml (IQR 427–1,700) vs. 514 ng/ml (IQR 356–833); ratio of means 1.56 (99.17% CI 0.97–2.53); P=0.01]. After adjustment for baseline confounders, the ratio of means of hsTNT at 6 h was 1.23 (99.17% CI 0.88–1.72; P=0.10) and at 12 h was 1.30 (99.17% CI 0.92–1.84; P=0.05). In the RIPC group, 35/48 (72.9%) had no AKI, 5/48 (10.4%) had AKI risk, and 8/48 (16.7%) had either renal injury or failure compared to the control group where 34/48 (70.8%) had no AKI, 7/48 (14.6%) had AKI risk, and 7/48 (14.6%) had renal injury or failure (Chi-squared 0.41; two degrees of freedom; P = 0.82). RIPC increased post-operative duration of noradrenaline support [21 h (IQR 7–45) vs. 9 h (IQR 3–19); ratio of means 1.70 (99.17% CI 0.86–3.34); P=0.04]. RIPC does not reduce hsTNT, AKI, or ICU-support requirements in high-risk cardiac surgery.

Keywords

Cardioprotection Cardiac surgery Remote ischemic preconditioning Reperfusion 

Notes

Acknowledgments

This study was funded by unrestricted grants from the New Zealand Lotteries Commission and the National Heart Foundation of New Zealand.

Conflicts of interest

None.

Supplementary material

395_2012_256_MOESM1_ESM.doc (100 kb)
Electronic supplementary material (DOC 100 kb)

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Paul Jeffrey Young
    • 1
    • 2
  • Paul Dalley
    • 1
  • Alexander Garden
    • 1
    • 3
  • Christopher Horrocks
    • 1
  • Anne La Flamme
    • 3
  • Barry Mahon
    • 1
  • John Miller
    • 3
  • Janine Pilcher
    • 2
  • Mark Weatherall
    • 2
    • 4
  • Jenni Williams
    • 3
  • William Young
    • 1
  • Richard Beasley
    • 1
    • 2
  1. 1.Wellington Hospital, Capital and Coast District Health BoardWellingtonNew Zealand
  2. 2.Medical Research Institute of New ZealandWellingtonNew Zealand
  3. 3.School of Biological SciencesVictoria University of WellingtonWellingtonNew Zealand
  4. 4.University of Otago, WellingtonWellingtonNew Zealand

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