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Published on: August 2, 2019
Remote Ischemic Preconditioning Fails to Benefit Pediatric Patients Undergoing Congenital Cardiac Surgery: A
Hong-Tao Tie1, Ming-Zhu Luo, Zhen-Han Li
1From the Department of Cardiothoracic Surgery (H-TT, Q-CW, MZ, QL); The First Affiliated Hospital of Chongqing Medical University; Division of Immunology (M-ZL); The Children's Hospital of Chongqing Medical University; The First College of Clinical Medicine (Z-HL, QW); and Chongqing Medical University, Chongqing, China.
Insights
Remote ischemic preconditioning (RIPC) did not improve outcomes for pediatric patients undergoing congenital cardiac surgery (CCS). This meta-analysis found no significant changes in ventilation duration, ICU stay, or cardiac enzyme levels, suggesting RIPC may not be beneficial in this population.
Area of Science:
- Cardiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Remote ischemic preconditioning (RIPC) is a technique to reduce ischemia-reperfusion injury.
- Its efficacy in pediatric patients undergoing congenital cardiac surgery (CCS) remains inconsistent.
- A comprehensive evaluation is needed to clarify RIPC's role in pediatric CCS.
Purpose of the Study:
- To conduct a meta-analysis of randomized controlled trials (RCTs).
- To evaluate the effect of RIPC on clinical outcomes in pediatric patients undergoing CCS.
- To assess RIPC's impact on mechanical ventilation, ICU stay, cardiac biomarkers, and hospital length of stay.
Main Methods:
- Searched PubMed, Embase, and Cochrane Library for relevant RCTs.
- Included 9 RCTs involving 697 pediatric patients undergoing CCS.
- Performed meta-analysis using a random-effects model, including subgroup and sensitivity analyses.
Main Results:
- RIPC did not significantly alter the duration of mechanical ventilation (SMD -0.03, 95% CI -0.23-0.17).
- No significant differences were observed in ICU length of stay (SMD -0.22, 95% CI -0.47-0.04) or hospital length of stay (SMD -0.14, 95% CI -0.55-0.26).
- Postoperative cardiac troponin levels and inotropic scores were also not reduced by RIPC.
Conclusions:
- Remote ischemic preconditioning appears to have no beneficial effects in children undergoing congenital cardiac surgery.
- Findings should be interpreted cautiously due to study heterogeneity.
- Larger-scale randomized controlled trials are necessary to confirm these results.
Abstract:
Remote ischemic preconditioning (RIPC) has been proven to reduce the ischemia-reperfusion injury. However, its effect on children receiving congenital cardiac surgery (CCS) was inconsistent. We therefore performed the current meta-analysis of randomized controlled trials (RCTs) to comprehensively evaluate the effect of RIPC in pediatric patients undergoing CCS.PubMed, Embase, and Cochrane library were searched to identify RCTs assessing the effect of RIPC in pediatric patients undergoing CCS. The outcomes included the duration of mechanical ventilation (MV), intensive care unit (ICU) length of stay, postoperative cardiac troponin (cTnI) level, hospital length of stay (HLOS), postoperative inotropic score, and mortality. Subgroup and sensitivity analysis were also performed as predesigned. The meta-analysis was performed with random-effects model despite of heterogeneity. Sensitivity and subgroup analysis were predesigned to identify the robustness of the pooled estimate.Nine RCTs with 697 pediatric patients were included in the meta-analysis. Overall, RIPC failed to alter clinical outcomes of duration of MV (standard mean difference [SMD] -0.03, 95% confidence interval [CI] -0.23-0.17), ICU length of stay (SMD -0.22, 95% CI -0.47-0.04), or HLOS (SMD -0.14, 95% CI -0.55-0.26). Additionally, RIPC could not reduce postoperative cTnI (at 4-6 hours: SMD -0.25, 95% CI -0.73-0.23; P = 0.311; at 20-24 hours: SMD 0.09, 95% CI -0.51-0.68; P = 0.778) or postoperative inotropic score (at 4-6 hours: SMD -0.19, 95% CI -0.51-0.14; P = 0.264; at 24 hours: SMD -0.15, 95% CI -0.49-0.18; P = 0.365).RIPC may have no beneficial effects in children undergoing CCS. However, this finding should be interpreted with caution because of heterogeneity and large-scale RCTs are still needed.
