title: Does remote ischaemic preconditioning with postconditioning improve clinical outcomes of patients undergoing cardiac surgery? Remote Ischaemic Preconditioning with Postconditioning Outcome Trial.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether remote ischaemic preconditioning (RIPC) combined with remote ischaemic postconditioning (RIPostC) improves the clinical outcomes of patients undergoing cardiac surgery.
  
  
  RESULTS
  From June 2009 to November 2010, 1280 patients who underwent elective cardiac surgery were randomized into the RIPC with RIPostC group or the control group in the morning of the surgery. In the RIPC with RIPostC group, four cycles of 5-min ischaemia and 5-min reperfusion were administered twice to the upper limb-before cardiopulmonary bypass (CPB) or coronary anastomoses for RIPC and after CPB or coronary anastomoses for RIPostC. The primary endpoint was the composite of major adverse outcomes, including death, myocardial infarction, arrhythmia, stroke, coma, renal failure or dysfunction, respiratory failure, cardiogenic shock, gastrointestinal complication, and multiorgan failure. Remote ischaemic preconditioning with RIPostC did not reduce the composite outcome compared with the control group (38.0 vs. 38.1%, respectively; P = 0.998) and there was no difference in each major adverse outcome. The intensive care unit and hospital stays were not different between the two groups. However, in the off-pump coronary artery bypass surgery subgroup, multivariate logistic regression analysis revealed that RIPC with RIPostC was related to increased composite outcome (odds ratio: 1.54; 95% confidence interval: 1.02-2.30; P = 0.038).
  
  
  CONCLUSIONS
  Remote ischaemic preconditioning with RIPostC by transient upper limb ischaemia did not improve clinical outcome in patients who underwent cardiac surgery.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Daehakro 101 Seoul 110-744, South Korea.
authors.forename: Deok Man
authors.initials: DM
authors.lastname: Hong
authors.forename: Eun-Ho
authors.initials: EH
authors.lastname: Lee
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jeong Jin
authors.initials: JJ
authors.lastname: Min
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Chin
authors.forename: Dae-Kee
authors.initials: DK
authors.lastname: Choi
authors.forename: Jae-Hyon
authors.initials: JH
authors.lastname: Bahk
authors.forename: Ji-Yeon
authors.initials: JY
authors.lastname: Sim
authors.forename: In-Cheol
authors.initials: IC
authors.lastname: Choi
authors.forename: Yunseok
authors.initials: Y
authors.lastname: Jeon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D057775:Ischemic Postconditioning / Q000379:methods*; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiac surgery; Postconditioning; Preconditioning; Remote ischaemic preconditioning