title: Remote ischaemic preconditioning protects against cardiopulmonary bypass-induced tissue injury: a preclinical study.
abstract: OBJECTIVE
  To test the hypothesis that remote ischaemic preconditioning (rIPC) reduces injury after cardiopulmonary bypass (CPB).
  
  
  METHODS
  Randomised study with an experimental model of CPB (3 h CPB with 2 h of cardioplegic arrest). Twelve 15 kg pigs were randomly assigned to control or rIPC before CPB and followed up for 6 h.
  
  
  METHODS
  rIPC was induced by four 5 min cycles of lower limb ischaemia before CPB.
  
  
  METHODS
  Troponin I, glial protein S-100B, lactate concentrations, load-independent indices (conductance catheter) of systolic and diastolic function, and pulmonary resistance and compliance were measured before and for 6 h after CPB.
  
  
  RESULTS
  Troponin I increased after CPB in both groups but during reperfusion the rIPC group had lower concentrations than controls (mean area under the curve -57.3 (SEM 7.3) v 89.0 (11.6) ng.h/ml, p = 0.02). Lactate increased after CPB in both groups but during reperfusion the control group had significantly more prolonged hyperlactataemia (p = 0.04). S-100B did not differ between groups. Indices of ventricular function did not differ. There was a tendency to improved lung compliance (p = 0.07), and pulmonary resistance changed less in the rIPC than in the control group during reperfusion (p = 0.02). Subsequently, peak inspiratory pressure was lower (p = 0.001).
  
  
  CONCLUSIONS
  rIPC significantly attenuated clinically relevant markers of myocardial and pulmonary injury after CPB. Transient limb ischaemia as an rIPC stimulus has potentially important clinical applications.
authors.affiliation: University of Cambridge, Cambridge, UK. r.kharbanda@rbht.nhs.uk
authors.forename: R K
authors.initials: RK
authors.lastname: Kharbanda
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: I E
authors.initials: IE
authors.lastname: Konstantinov
authors.forename: M M H
authors.initials: MM
authors.lastname: Cheung
authors.forename: P A
authors.initials: PA
authors.lastname: White
authors.forename: H
authors.initials: H
authors.lastname: Frndova
authors.forename: J
authors.initials: J
authors.lastname: Stokoe
authors.forename: P
authors.initials: P
authors.lastname: Cox
authors.forename: M
authors.initials: M
authors.lastname: Vogel
authors.forename: G
authors.initials: G
authors.lastname: Van Arsdell
authors.forename: R
authors.initials: R
authors.lastname: MacAllister
authors.forename: A N
authors.initials: AN
authors.lastname: Redington
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D019344:Lactic Acid / Q000378:metabolism; D008168:Lung / Q000502:physiology; D017202:Myocardial Ischemia / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D015428:Myocardial Reperfusion Injury / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D009414:Nerve Growth Factors / Q000378:metabolism; D011897:Random Allocation; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000378:metabolism; D013552:Swine; D019210:Troponin I / Q000378:metabolism; D014655:Vascular Resistance
chemical_list: D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D019210:Troponin I; D019344:Lactic Acid