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Published on: May 26, 2023
Remote ischemic preconditioning in children undergoing cardiac surgery with cardiopulmonary bypass: a single-center
Brian W McCrindle1, Nadia A Clarizia2, Svetlana Khaikin2
1Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada (B.W.M.C., N.A.C., S.K., H.M.H., C.M., S.M.S., C.A.C., J.G.C., G.S.V.A., A.N.R.) Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (B.W.M.C., A.N.R.).
Insights
Remote ischemic preconditioning (RIPC) did not improve clinical outcomes or reduce injury markers in children undergoing cardiac surgery. This study found no significant difference in hospital stay or physiological markers between RIPC and sham groups.
Area of Science:
- Cardiovascular Surgery
- Pediatric Critical Care
- Ischemia-Reperfusion Injury
Background:
- Cardiac surgery with cardiopulmonary bypass can cause ischemia-reperfusion injury and inflammation.
- Remote ischemic preconditioning (RIPC) is a protective mechanism against such injuries.
- The study investigated RIPC's effect on pediatric cardiac surgery outcomes.
Purpose of the Study:
- To determine if RIPC impacts clinical outcomes after pediatric cardiac surgery.
- To assess RIPC's effect on physiological markers of ischemia-reperfusion injury and inflammation.
- To evaluate RIPC's safety in pediatric patients.
Main Methods:
- A randomized controlled trial involving 299 children (neonate to 17 years).
- RIPC group received a blood pressure cuff stimulus; control group received a sham stimulus.
- Primary outcome was postoperative hospital stay; secondary outcomes included clinical and laboratory markers.
Main Results:
- No significant difference in postoperative hospital stay between RIPC (5.6 days) and sham (5.4 days) groups.
- Few significant differences observed in other clinical outcomes or physiological markers.
- Adverse events were similar between groups (5% sham, 6% RIPC).
Conclusions:
- RIPC did not demonstrate significant clinical benefits in children undergoing cardiac surgery.
- The protective effects of RIPC were not observed in this pediatric population.
- RIPC is not associated with improved outcomes or reduced injury markers in this context.
Background:
Remote ischemic preconditioning (RIPC) harnesses an innate defensive mechanism that protects against inflammatory activation and ischemia-reperfusion injury, known sequelae of cardiac surgery with cardiopulmonary bypass. We sought to determine the impact of RIPC on clinical outcomes and physiological markers related to ischemia-reperfusion injury and inflammatory activation after cardiac surgery in children.
Methods And Results:
Overall, 299 children (aged neonate to 17 years) were randomized to receive an RIPC stimulus (inflation of a blood pressure cuff on the left thigh to 15 mm Hg above systolic for four 5-minute intervals) versus a blinded sham stimulus during induction with a standardized anesthesia protocol. Primary outcome was duration of postoperative hospital stay, with serial clinical and laboratory measurements for the first 48 postoperative hours and clinical follow-up to discharge. There were no significant baseline differences between RIPC (n=148) and sham (n=151). There were no in-hospital deaths. No significant difference in length of postoperative hospital stay was noted (sham 5.4 versus RIPC 5.6 days; difference +0.2; adjusted P=0.91), with the 95% confidence interval (-0.7 to +0.9) excluding a prespecified minimal clinically significant differences of 1 or 1.5 days. There were few significant differences in other clinical outcomes or values at time points or trends in physiological markers. Benefit was not observed in specific subgroups when explored through interactions with categories of age, sex, surgery type, Aristotle score, or first versus second half of recruitment. Adverse events were similar (sham 5%, RIPC 6%; P=0.68).
Conclusions:
RIPC is not associated with important improvements in clinical outcomes and physiological markers after cardiac surgery in children.
Clinical Trial Registration Url:
clinicaltrials.gov. Unique identifier: NCT00650507.
