C P Twine1, S Ferguson2, J R Boyle2. 1. South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK. Electronic address: chris_twine@hotmail.com. 2. Addenbrooke's Hospital, Cambridge, UK.
Abstract
OBJECTIVES: Remote ischaemic preconditioning (RIPC) is a physiological mechanism to protect against ischaemia-reperfusion injury. It is a technique in which short pre-emptive periods of ischaemia and reperfusion are thought to protect against ischaemia-reperfusion injury during procedures requiring longer periods of ischaemia. Discovered in the 1980s, its clinical application has been investigated heavily since the first human study in 2006. The aim of this paper was to provide a review of this rapidly expanding subject. METHODS: This study consists of a narrative review of the literature focusing on previous meta-analyses and randomised control trials. RESULTS: Five small randomised trials have been published on the effects of RIPC in vascular surgery. Several randomised trials have been published in cardiac surgery and percutaneous coronary intervention. Meta-analysis shows a significant reduction in troponin levels and biomarkers of renal dysfunction in RIPC patients, but as yet no convincing clinical benefit. The largest powered randomised trial in cardiac surgery showed no benefit to RIPC. CONCLUSIONS: Current trials and therefore meta-analyses are generally underpowered. The technique is physiologically sound but remains lacking in clear clinical benefit.
OBJECTIVES: Remote ischaemic preconditioning (RIPC) is a physiological mechanism to protect against ischaemia-reperfusion injury. It is a technique in which short pre-emptive periods of ischaemia and reperfusion are thought to protect against ischaemia-reperfusion injury during procedures requiring longer periods of ischaemia. Discovered in the 1980s, its clinical application has been investigated heavily since the first human study in 2006. The aim of this paper was to provide a review of this rapidly expanding subject. METHODS: This study consists of a narrative review of the literature focusing on previous meta-analyses and randomised control trials. RESULTS: Five small randomised trials have been published on the effects of RIPC in vascular surgery. Several randomised trials have been published in cardiac surgery and percutaneous coronary intervention. Meta-analysis shows a significant reduction in troponin levels and biomarkers of renal dysfunction in RIPC patients, but as yet no convincing clinical benefit. The largest powered randomised trial in cardiac surgery showed no benefit to RIPC. CONCLUSIONS: Current trials and therefore meta-analyses are generally underpowered. The technique is physiologically sound but remains lacking in clear clinical benefit.