Remote Ischemic Preconditioning in Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Single‐Center Double‐Blinded Randomized Trial

@article{McCrindle2014RemoteIP,
  title={Remote Ischemic Preconditioning in Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Single‐Center Double‐Blinded Randomized Trial},
  author={Brian W. McCrindle and Nadia A. Clarizia and Svetlana Khaikin and Helen M. Holtby and Cedric Manlhiot and Steven M. Schwartz and Christopher A. Caldarone and John G. Coles and Glen S. van Arsdell and Stephen W. Scherer and Andrew N. Redington},
  journal={Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease},
  year={2014},
  volume={3}
}
Background Remote ischemic preconditioning (RIPC) harnesses an innate defensive mechanism that protects against inflammatory activation and ischemia‐reperfusion injury, known sequelae of cardiac surgery with cardiopulmonary bypass. We sought to determine the impact of RIPC on clinical outcomes and physiological markers related to ischemia‐reperfusion injury and inflammatory activation after cardiac surgery in children. Methods and Results Overall, 299 children (aged neonate to 17 years) were… Expand

Paper Mentions

Interventional Clinical Trial
Survival rates of children with cancers have improved significantly in the recent few decades. Nonetheless, the side effect of this class of drugs on heart function remains to be… Expand
ConditionsCardiotoxicity
InterventionOther, Procedure
A Prospective Randomised Blinded Trial of Remote Ischaemic Preconditioning in children undergoing cardiac surgery.
TLDR
Remote ischaemic preconditioning in children undergoing CPB 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. Expand
Remote Ischemic Preconditioning and Outcomes of Cardiac Surgery.
TLDR
Remote ischemic preconditioning did not improve clinical outcomes in patients undergoing elective on-pump CABG with or without valve surgery and there were no significant between-group differences in either adverse events or the secondary end points of perioperative myocardial injury. Expand
Cardiac protective effects of remote ischaemic preconditioning in children undergoing tetralogy of fallot repair surgery: a randomized controlled trial
TLDR
In ToF children undergoing open heart surgery, RIPC attenuates myocardial IRI and improves the short-term prognosis, although its effectiveness in adults with comorbidities is controversial. Expand
Remote Ischemic Preconditioning Does Not Prevent White Matter Injury in Neonates.
TLDR
There was no evidence that use of RIPC provides neuroprotection in neonates undergoing repair of congenital heart defects with cardiopulmonary bypass in this randomized, blinded clinical trial. Expand
Remote Ischemic Preconditioning Fails to Benefit Pediatric Patients Undergoing Congenital Cardiac Surgery
TLDR
RIPC may have no beneficial effects in children undergoing CCS, and this finding should be interpreted with caution because of heterogeneity and large-scale RCTs are still needed. Expand
Remote Ischemic Preconditioning for Cardiac Surgery: Reflections on Evidence of Efficacy.
TLDR
A reconciliatory yet objective review of cumulative evidence with regard to cardiac surgery reveals that RIPC in preclinical studies reduced infarct size after experimental myocardial infarction, which is different from cardiac surgery; improved release of biomarkers, but not hard clinical end points, in proof-of-concept clinical trials with discordant results; and failed to produce significant improvement in outcomes in meta-analyses. Expand
Impact of ischemic preconditioning on surgical treatment of brain tumors: a single-center, randomized, double-blind, controlled trial
TLDR
Application of rIPC was associated with reduced incidence of postoperative ischemic tissue damage in patients undergoing elective brain tumor surgery, the first study indicating a benefit of r IPC in brain tumors surgery. Expand
Effect of Remote Ischaemic preconditioning on Clinical outcomes in patients undergoing Coronary Artery bypass graft surgery (ERICCA study): a multicentre double-blind randomised controlled clinical trial
TLDR
In patients undergoing elective on-pump CABG with or without valve surgery, without standardisation of the anaesthetic regimen, RIPC using transient arm ischaemia–reperfusion did not improve clinical outcomes. Expand
A randomized, single-blinded cross-over trial of ischemic preconditioning in Raynaud's phenomenon
TLDR
No significant differences in RP disease activity were found between IPC and sham, and results were not significant, which could be due to lack of effect of IPC on RP, too few treatments, or sham having a partial effect. Expand
Bilateral Remote Ischaemic Conditioning in Children (BRICC) trial: protocol for a two-centre, double-blind, randomised controlled trial in young children undergoing cardiac surgery
TLDR
The Bilateral Remote Ischaemic Conditioning in Children (BRICC) trial will assess whether remote ischaemic preconditioning, applied to both lower limbs immediately prior to surgery, reduces myocardial injury in cyanotic and acyanotic young children. Expand
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References

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Randomized controlled trial of the effects of remote ischemic preconditioning on children undergoing cardiac surgery: first clinical application in humans.
TLDR
The myocardial protective effects of RIPC are demonstrated using a simple noninvasive technique of four 5-min cycles of lower limb ischemia and reperfusion using a blood pressure cuff in children undergoing repair of congenital heart defects. Expand
Late remote ischemic preconditioning in children undergoing cardiopulmonary bypass: a randomized controlled trial.
TLDR
Late remote ischemic preconditioning did not provide clinically relevant cardioprotection to children undergoing cardiopulmonary bypass andPostoperative morbidity was similar in both groups; there were no postoperative deaths in either group. Expand
Remote ischemic preconditioning in cyanosed neonates undergoing cardiopulmonary bypass: a randomized controlled trial.
TLDR
The data suggest that remote ischemic preconditioning in hypoxic neonates undergoing cardiopulmonary bypass surgery does not provide myocardial, renal, or neuronal protection. Expand
Limb Ischemic Preconditioning Reduces Heart and Lung Injury After an Open Heart Operation in Infants
TLDR
Limb RIPC can be applied safely and easily in infants, can attenuate systemic inflammatory response syndrome, and can increase systemic tolerance to IRI, imparting a protective effect against myocardial and pulmonary IRI. Expand
Failure of remote ischemic preconditioning to reduce the risk of postoperative acute kidney injury in children undergoing operation for complex congenital heart disease: a randomized single-center study.
TLDR
No evidence was found that remote ischemic preconditioning provided protection of kidney function in children undergoing operation for complex congenital heart disease. Expand
Effect of Remote Ischemic Preconditioning on Phosphorylated Protein Signaling in Children Undergoing Tetralogy of Fallot Repair: A Randomized Controlled Trial
TLDR
In patients with cyanotic heart disease, a high proportion of proteins are in phosphorylated form, and RIPC does not further enhance phosphorylation protein signaling in myocardium or circulating leukocytes in children undergoing ToF repair. Expand
Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: A Prospective, Randomized Control Trial
TLDR
Remote IPC reduces ischemic chest discomfort during PCI, attenuates procedure-related cTnI release, and appears to reduce subsequent cardiovascular events. Expand
Remote Ischemic Preconditioning Applied during Isoflurane Inhalation Provides No Benefit to the Myocardium of Patients Undergoing On-pump Coronary Artery Bypass Graft Surgery: Lack of Synergy or Evidence of Antagonism in Cardioprotection?
TLDR
RIPC applied during isoflurane inhalation provides no benefit to the myocardium of patients undergoing on-pump coronary artery bypass grafting and there was no difference in the 6-month cardiovascular outcome. Expand
Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial
TLDR
It is shown that adult patients undergoing elective coronary artery bypass graft surgery at a single tertiary centre could benefit from remote ischaemic preconditioning, using transient upper limb ischaemia. Expand
Sevoflurane preconditioning at 1 MAC only provides limited protection in patients undergoing coronary artery bypass surgery: a randomized bi-centre trial.
TLDR
This study did not show a significant preconditioning signal after 15 min of sevoflurane administration, and there were fewer patients with low postoperative cardiac index in S group (11% in S vs 35% in control group, P < 0.05) when considering the per protocol population. Expand
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