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Remote Limb Ischemic Preconditioning: A Neuroprotective Technique in Rodents
Published on: June 2, 2015
A Prospective Randomized Blinded Trial of Remote Ischemic Preconditioning in Children Undergoing Cardiac Surgery
Maribel Carolina Verdesoto Rodriguez1, Neil Spenceley2, Maria Ilina2
1University of Glasgow, Glasgow, United Kingdom.
Insights
Remote ischemic preconditioning (RIPC) in children undergoing cardiopulmonary bypass reduced ICU stay and TNF-α levels. However, RIPC did not improve cardiac or renal function, suggesting limited clinical benefit despite some inflammatory marker changes.
Area of Science:
- Cardiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Remote ischemic preconditioning (RIPC) is explored for myocardial protection during cardiopulmonary bypass (CPB).
- Its efficacy in pediatric patients undergoing CPB requires further investigation.
Purpose of the Study:
- To evaluate the impact of RIPC on clinical outcomes, cardiac and end-organ function, and inflammatory responses in children undergoing CPB.
- To assess myocardial gene expression changes following RIPC.
Main Methods:
- A prospective, investigator-blinded, randomized controlled trial.
- Patients received RIPC (three 5-minute cycles of limb ischemia-reperfusion) 1 and 12 hours preoperatively or served as controls.
- Clinical outcomes, cardiac function (echocardiography), renal function, inflammatory markers (TNF-α), and myocardial gene expression (HSP-60) were assessed.
Main Results:
- RIPC patients had significantly shorter ICU stays (1.8 vs. 4.9 days, P=0.029).
- Postoperative TNF-α levels were significantly reduced in the RIPC group (P=0.02).
- No significant differences were observed in biventricular function, troponin levels, or renal function between groups. HSP-60 myocardial expression was lower in the RIPC group (P=0.05).
Conclusions:
- RIPC in pediatric CPB is associated with reduced ICU stay and lower TNF-α levels.
- RIPC did not demonstrate significant protection against cardiac injury or renal dysfunction in this cohort.
- The observed association with shorter ICU stay may be influenced by unmeasured factors.
Abstract:
Remote ischemic preconditioning (RIPC) has been proposed as an intervention to protect myocardium and attenuate end-organ dysfunction associated with cardiopulmonary bypass. We investigated the effect of RIPC in children undergoing cardiopulmonary bypass involving clinical outcome, cardiac and end-organ function, inflammatory response, and myocardial gene expression. A prospective, investigator-blinded, randomized, controlled trial was performed. Patients were randomized into RIPC or Control; RIPC consisted of three 5-minute cycles of limb ischemia-reperfusion taking place 1 and 12 hours preoperatively. Clinical outcomes included cardiac function, ICU surveillance, and renal function. In addition, inflammatory markers and myocardial gene expression were evaluated. RIPC patients required shorter ICU stay (days), RIPC: 1.8 (0.94-3.88) vs Control: 4.9 (1.63-7.20), P = 0.029. Echocardiography parameters demonstrated reduced biventricular function following surgery showing no difference between groups. A nonsignificant trend for reduced troponin was observed following RIPC: AUC analysis, RIPC: 393.05 (98.85-1038.73) vs Control: 596.10 (225.38-954.24) P = 0.75. B-type natriuretic peptide and renal function parameters were similar between groups. Postoperative TNF-α was significantly reduced after RIPC, RIPC: 15.42 (7.81-114.86) vs Control: 108.98 (42.28-301.19) P = 0.02. Remaining inflammatory markers demonstrated no significant difference between groups. HSP-60 showed lower myocardial expression following RIPC, RIPC: 3.95 (2.69-6.28) vs Control: 6.83 (4.74-8.81), P = 0.05. Expression of other analyzed genes was not influenced by RIPC. RIPC was associated with shorter ICU stay and reduced TNF-α but did not influence other clinical outcomes, not confer protection against cardiac injury or renal dysfunction. The association between RIPC and ICU stay may be influenced by unaccounted latent variables, including cardiac morphology.
