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A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery
Patrick Meybohm1, Berthold Bein, Oana Brosteanu
1From the Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Frankfurt (P.M., U.S., C.R., K.Z.), the Departments of Anesthesiology and Intensive Care Medicine (P.M., B.B., M.G.) and Cardiovascular Surgery (J.C.), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Clinical Trial Center (O.B.), the Department of Internal Medicine/Cardiology, University of Leipzig Heart Center (G.F.), and Institute for Medical Informatics, Statistics, and Epidemiology (D.H.), University of Leipzig, Leipzig, the Department of Anesthesiology, University Hospital Aachen, Aachen (C.S., M.C., G.S.), the Department of Cardiovascular Surgery, University of Giessen, Giessen (A.B., B.N.), Clinic of Anesthesiology and Intensive Care Medicine, University Hospital Rostock, Rostock (J.R., F.K.), the Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Mainz (R.L.-F., M.F.), the Department of Anesthesiology and Intensive Care Medicine, University Hospital Göttingen, Göttingen (I.F.B., M.B.), the Department of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital, Jena (S.N.S., A.K.), the Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn (M.W., G.B.), the Department of Anesthesiology and Intensive Care Medicine, University Hospital Düsseldorf, Düsseldorf (T.M.-T., P.K.), the Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Lübeck (M.H., J.S.), the Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin (M.S., S.T.), the Department of Anesthesiology, University Hospital Würzburg, Würzburg (T. Smul, E.W.), and the Department of Anesthesiology, University Hospital Magdeburg, Magdeburg (T. Schilling) - all in Germany.
Remote ischemic preconditioning (RIPC) did not significantly reduce adverse outcomes in patients undergoing cardiac surgery. This study found no relevant benefit of RIPC when administered under propofol anesthesia.
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Remote ischemic preconditioning (RIPC) is a technique that may reduce injury from ischemia and reperfusion during cardiac surgery.
- However, its effectiveness in improving clinical outcomes remains uncertain.
Purpose of the Study:
- To evaluate the efficacy of upper-limb RIPC in reducing major adverse events in patients undergoing elective cardiac surgery.
- To assess the impact of RIPC on biomarkers, ventilation duration, and hospital length of stay.
Main Methods:
- A prospective, double-blind, multicenter, randomized controlled trial was conducted.
- Adults undergoing elective cardiac surgery with cardiopulmonary bypass under propofol anesthesia received either upper-limb RIPC or a sham intervention.
- The primary endpoint was a composite of death, myocardial infarction, stroke, or acute renal failure at hospital discharge.
Main Results:
- A total of 1385 patients were analyzed, with no significant difference in the composite primary endpoint between the RIPC and sham groups (14.3% vs. 14.6%, P=0.89).
- Individual components including death, myocardial infarction, stroke, and acute renal failure also showed no significant differences between groups.
- No significant differences were observed in troponin release, mechanical ventilation duration, ICU/hospital stay, new-onset atrial fibrillation, or postoperative delirium.
Conclusions:
- Upper-limb RIPC administered during propofol-induced anesthesia did not provide a relevant clinical benefit for patients undergoing elective cardiac surgery.
- No RIPC-related adverse events were reported, indicating a safe profile for the intervention in this context.
