TY - JOUR T1 - Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (Remote IMPACT): a randomized controlled trial JF - Canadian Medical Association Journal JO - CMAJ SP - 329 LP - 336 DO - 10.1503/cmaj.150632 VL - 188 IS - 5 AU - Michael Walsh AU - Richard Whitlock AU - Amit X. Garg AU - Jean-François Légaré AU - Andra E. Duncan AU - Robert Zimmerman AU - Scott Miller AU - Stephen Fremes AU - Teresa Kieser AU - Ganesan Karthikeyan AU - Matthew Chan AU - Anthony Ho AU - Vivian Nasr AU - Jessica Vincent AU - Imtiaz Ali AU - Ronit Lavi AU - Daniel I. Sessler AU - Robert Kramer AU - Jeff Gardner AU - Summer Syed AU - Tomas VanHelder AU - Gordon Guyatt AU - Purnima Rao-Melacini AU - Lehana Thabane AU - P.J. Devereaux A2 - , Y1 - 2016/03/15 UR - http://www.cmaj.ca/content/188/5/329.abstract N2 - Background: Remote ischemic preconditioning is a simple therapy that may reduce cardiac and kidney injury. We undertook a randomized controlled trial to evaluate the effect of this therapy on markers of heart and kidney injury after cardiac surgery.Methods: Patients at high risk of death within 30 days after cardiac surgery were randomly assigned to undergo remote ischemic preconditioning or a sham procedure after induction of anesthesia. The preconditioning therapy was three 5-minute cycles of thigh ischemia, with 5 minutes of reperfusion between cycles. The sham procedure was identical except that ischemia was not induced. The primary outcome was peak creatine kinase–myocardial band (CK-MB) within 24 hours after surgery (expressed as multiples of the upper limit of normal, with log transformation). The secondary outcome was change in creatinine level within 4 days after surgery (expressed as log-transformed micromoles per litre). Patient-important outcomes were assessed up to 6 months after randomization.Results: We randomly assigned 128 patients to remote ischemic preconditioning and 130 to the sham therapy. There were no significant differences in postoperative CK-MB (absolute mean difference 0.15, 95% confidence interval [CI] −0.07 to 0.36) or creatinine (absolute mean difference 0.06, 95% CI −0.10 to 0.23). Other outcomes did not differ significantly for remote ischemic preconditioning relative to the sham therapy: for myocardial infarction, relative risk (RR) 1.35 (95% CI 0.85 to 2.17); for acute kidney injury, RR 1.10 (95% CI 0.68 to 1.78); for stroke, RR 1.02 (95% CI 0.34 to 3.07); and for death, RR 1.47 (95% CI 0.65 to 3.31).Interpretation: Remote ischemic precnditioning did not reduce myocardial or kidney injury during cardiac surgery. This type of therapy is unlikely to substantially improve patient-important outcomes in cardiac surgery. Trial registration: ClinicalTrials.gov, no. NCT01071265. ER -