RT Journal Article
SR Electronic
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
FD Canadian Medical Association
SP 329
OP 336
DO 10.1503/cmaj.150632
VO 188
IS 5
A1 Michael Walsh
A1 Richard Whitlock
A1 Amit X. Garg
A1 Jean-François Légaré
A1 Andra E. Duncan
A1 Robert Zimmerman
A1 Scott Miller
A1 Stephen Fremes
A1 Teresa Kieser
A1 Ganesan Karthikeyan
A1 Matthew Chan
A1 Anthony Ho
A1 Vivian Nasr
A1 Jessica Vincent
A1 Imtiaz Ali
A1 Ronit Lavi
A1 Daniel I. Sessler
A1 Robert Kramer
A1 Jeff Gardner
A1 Summer Syed
A1 Tomas VanHelder
A1 Gordon Guyatt
A1 Purnima Rao-Melacini
A1 Lehana Thabane
A1 P.J. Devereaux
A1 ,
YR 2016
UL http://www.cmaj.ca/content/188/5/329.abstract
AB 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.