title: Late remote ischemic preconditioning in children undergoing cardiopulmonary bypass: a randomized controlled trial.
abstract: OBJECTIVE
  Cardiopulmonary bypass is associated with ischemia-reperfusion injury to multiple organs. We aimed to evaluate whether remote ischemic preconditioning performed the day before surgery for congenital heart disease with cardiopulmonary bypass attenuates the postoperative inflammatory response and myocardial dysfunction.
  
  
  METHODS
  This was a prospective, randomized, single-blind, controlled trial. Children allocated to remote ischemic preconditioning underwent 4 periods of 5 minutes of lower limb ischemia by a blood pressure cuff intercalated with 5 minutes of reperfusion. Blood samples were collected 4, 12, 24, and 48 hours after cardiopulmonary bypass to evaluate nuclear factor kappa B activation in leukocytes by quantification of mRNA of I kappa B alpha by real-time quantitative polymerase chain reaction and for interleukin-8 and 10 plasma concentration measurements by enzyme-linked immunosorbent assay. Myocardial dysfunction was assessed by N-terminal pro-B-type natriuretic peptide and cardiac troponin I plasma concentrations, measured by chemiluminescence, and clinical parameters of low cardiac output syndrome.
  
  
  RESULTS
  Twelve children were allocated to remote ischemic preconditioning, and 10 children were allocated to the control group. Demographic data and Risk Adjustment for Congenital Heart Surgery 1 classification were comparable in both groups. Remote ischemic preconditioning group had lower postoperative values of N-terminal pro-B-type natriuretic peptide, but cardiac troponin I levels were not significantly different between groups. Interleukin-8 and 10 concentrations and I kappa B alpha gene expression were similar in both groups. Postoperative morbidity was similar in both groups; there were no postoperative deaths in either group.
  
  
  CONCLUSIONS
  Late remote ischemic preconditioning did not provide clinically relevant cardioprotection to children undergoing cardiopulmonary bypass.
authors.affiliation: Division of Pediatric Critical Care Medicine, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Marcos A
authors.initials: MA
authors.lastname: Pavione
authors.forename: Fabio
authors.initials: F
authors.lastname: Carmona
authors.forename: Margaret
authors.initials: M
authors.lastname: de Castro
authors.forename: Ana P C P
authors.initials: AP
authors.lastname: Carlotti
mesh_terms: D002315:Cardiopulmonary Bypass; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D016753:Interleukin-10 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D019194:Ischemic Preconditioning; D007866:Leg / Q000098:blood supply; D016014:Linear Models; D008297:Male; D016328:NF-kappa B / Q000097:blood; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D016209:Interleukin-8; D016328:NF-kappa B; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D016753:Interleukin-10