Abstract
Introduction: A number of proof-of-concept trials suggest that
remote ischaemic preconditioning (RIPC) reduces surrogate markers
of end-organ injury in patients undergoing major cardiovascular
surgery. There are currently no studies with clinical outcomes as
primary endpoints.
Aim: To evaluate the effect of RIPC on clinical outcomes following
cardiovascular surgery.
Methods: Randomised clinical trials of RIPC in major adult cardiovascular surgery were identified by a systematic review of electronic
abstract databases, conference proceedings and article reference lists.
Clinical end-points were extracted from trial reports. In addition, trial
principal investigators provided unpublished clinical outcome data.
Results: In total, 23 trials of RIPC in 2200 patients undergoing major
adult cardiovascular surgery were identified. RIPC did not have a
significant effect on clinical end-points (death, peri-operative myocardial infarction (MI), renal failure, stroke, mesenteric ischaemia,
hospital or critical care length of stay).
Conclusion: Pooled data from pilot trials cannot confirm that RIPC
has any significant effect on clinically relevant end-points. Heterogeneity in study inclusion and exclusion criteria and in the type of
preconditioning stimulus limits the potential for extrapolation at
present. An effort must be made to clarify the optimal preconditioning
stimulus. Following this, large-scale trials in a range of patient populations are required to ascertain the role of this simple, cost-effective
intervention in routine practice.
| Original language | English (Ireland) |
|---|---|
| Title of host publication | XXXIXth Sir Peter Freyer Memorial Lecture and Surgical Symposium |
| Publication status | Published - 1 Sep 2014 |
Authors (Note for portal: view the doc link for the full list of authors)
- Authors
- Healy, D; Bashar, K; Moloney, MC; Walsh, S