Ischemic Preconditioning Ineffectual Before Cardiac Surgery
|
By HospiMedica International staff writers Posted on 25 Oct 2015 |
|
A new study suggests that cycles of upper arm remote ischemic preconditioning (RIPC) before heart surgery has no effect on outcomes.
Researchers at University Hospital Frankfurt (Germany), University Hospital Göttingen (Germany) and other institutions in Germany conducted a prospective, randomized trial involving 1,385 adults (692 study cohort and 693 shams) scheduled for elective cardiac surgery requiring cardiopulmonary bypass. The primary end point was a composite of death, myocardial infarction (MI), stroke, or acute renal failure up to hospital discharge. Secondary end points included the occurrence of any individual component of the primary end point by day 90.
The results showed no significant between-group difference in the rate of the composite primary end point, or of any of the individual components; the results were similar in the per-protocol analysis, and no treatment effect was found in any subgroup analysis. No significant differences between the RIPC group and the sham-RIPC group were seen in level of troponin release, duration of mechanical ventilation, length of stay in the ICU or the hospital, new onset of atrial fibrillation, and incidence of postoperative delirium. No RIPC-related adverse events were observed. The study was published on October 8, 2015, in the New England Journal of Medicine (NEJM).
“The preconditioning protocol had no impact on the primary composite endpoint of death, MI, stroke, or acute renal failure up to the time of hospital discharge, compared with sham conditioning before elective cardiac surgery requiring cardiopulmonary bypass,” concluded lead author Patrick Meybohm, MD, of University Hospital Frankfurt, and colleagues. “Negative findings did not rule out a possible benefit from other remote ischemic preconditioning protocols, such as those done on lower limbs, with a longer duration of ischemia, or more cycles of preconditioning.”
RIPC involves repetitive cycles of transient ischemia of non-vital tissue to help remote vital organs withstand a subsequent prolonged ischemic event and the eventual reperfusion. It usually consists of 3¬–4 five-minute cycles of right upper arm ischemia, induced by an automated cuff inflated to 200 mmHg, with an intervening five minutes of reperfusion during which the cuff is deflated.
Related Links:
University Hospital Frankfurt
University Hospital Göttingen
Researchers at University Hospital Frankfurt (Germany), University Hospital Göttingen (Germany) and other institutions in Germany conducted a prospective, randomized trial involving 1,385 adults (692 study cohort and 693 shams) scheduled for elective cardiac surgery requiring cardiopulmonary bypass. The primary end point was a composite of death, myocardial infarction (MI), stroke, or acute renal failure up to hospital discharge. Secondary end points included the occurrence of any individual component of the primary end point by day 90.
The results showed no significant between-group difference in the rate of the composite primary end point, or of any of the individual components; the results were similar in the per-protocol analysis, and no treatment effect was found in any subgroup analysis. No significant differences between the RIPC group and the sham-RIPC group were seen in level of troponin release, duration of mechanical ventilation, length of stay in the ICU or the hospital, new onset of atrial fibrillation, and incidence of postoperative delirium. No RIPC-related adverse events were observed. The study was published on October 8, 2015, in the New England Journal of Medicine (NEJM).
“The preconditioning protocol had no impact on the primary composite endpoint of death, MI, stroke, or acute renal failure up to the time of hospital discharge, compared with sham conditioning before elective cardiac surgery requiring cardiopulmonary bypass,” concluded lead author Patrick Meybohm, MD, of University Hospital Frankfurt, and colleagues. “Negative findings did not rule out a possible benefit from other remote ischemic preconditioning protocols, such as those done on lower limbs, with a longer duration of ischemia, or more cycles of preconditioning.”
RIPC involves repetitive cycles of transient ischemia of non-vital tissue to help remote vital organs withstand a subsequent prolonged ischemic event and the eventual reperfusion. It usually consists of 3¬–4 five-minute cycles of right upper arm ischemia, induced by an automated cuff inflated to 200 mmHg, with an intervening five minutes of reperfusion during which the cuff is deflated.
Related Links:
University Hospital Frankfurt
University Hospital Göttingen
Gold Member
12-Channel ECG
CM1200B
Open Stapler
PROXIMATE Linear Cutter
ow Frequency Pulse Massager
ET10 L
Latest Surgical Techniques News
- Surgical Robot Makes Complex Liver Tumor Surgery Safer and Less Invasive
- Neurostimulation Implant Reduces Seizure Burden in Drug-Resistant Epilepsy
- Minimally Invasive Procedure Effectively Treats Small Kidney Cancers
- Fluorescence Probe Paired with Engineered Enzymes Lights Up Tumors for Easier Surgical Removal
- Novel Hydrogel Could Become Bone Implant of the Future
- Skull Implant Design Could Shape Surgical Outcomes
- Redesigned Surgical Laser Cuts Bone Deeper and Faster Than Before
- New Method Offers Less Invasive Detection of Susceptibility to Rare Anesthesia Reaction
- Laser Ablation Plus Immunotherapy Improves Survival in Recurrent Glioblastoma
- Brain Implant Records Neural Signals and Delivers Precise Medication
- AI-Based OCT Image Analysis Identifies High-Risk Plaques in Coronary Arteries
- Neural Device Regrows Surrounding Skull After Brain Implantation
- Surgical Innovation Cuts Ovarian Cancer Risk by 80%
- New Imaging Combo Offers Hope for High-Risk Heart Patients
- New Classification System Brings Clarity to Brain Tumor Surgery Decisions
- Boengineered Tissue Offers New Hope for Secondary Lymphedema Treatment
Channels
Artificial Intelligence
view channel
Critical Care
view channel
Single Heart Attack Shot to Revolutionize Cardiac Care
Surviving a heart attack often marks the beginning of a long recovery period, during which the heart can remain vulnerable to damage and long-term weakening. Current treatments focus on stabilizing patients... Read more
Single Mid-Wave Infrared Thermal Camera Enables Noncontact Vital Signs Monitoring
Infrared thermal cameras are widely used to measure surface temperatures and have become common tools for fever screening during infectious disease outbreaks. However, body temperature alone often provides... Read more
Patient Care
view channel
Revolutionary Automatic IV-Line Flushing Device to Enhance Infusion Care
More than 80% of in-hospital patients receive intravenous (IV) therapy. Every dose of IV medicine delivered in a small volume (<250 mL) infusion bag should be followed by subsequent flushing to ensure... Read more
VR Training Tool Combats Contamination of Portable Medical Equipment
Healthcare-associated infections (HAIs) impact one in every 31 patients, cause nearly 100,000 deaths each year, and cost USD 28.4 billion in direct medical expenses. Notably, up to 75% of these infections... Read more
Portable Biosensor Platform to Reduce Hospital-Acquired Infections
Approximately 4 million patients in the European Union acquire healthcare-associated infections (HAIs) or nosocomial infections each year, with around 37,000 deaths directly resulting from these infections,... Read more
First-Of-Its-Kind Portable Germicidal Light Technology Disinfects High-Touch Clinical Surfaces in Seconds
Reducing healthcare-acquired infections (HAIs) remains a pressing issue within global healthcare systems. In the United States alone, 1.7 million patients contract HAIs annually, leading to approximately... Read moreHealth IT
view channel
EMR-Based Tool Predicts Graft Failure After Kidney Transplant
Kidney transplantation offers patients with end-stage kidney disease longer survival and better quality of life than dialysis, yet graft failure remains a major challenge. Although a successful transplant... Read more
Printable Molecule-Selective Nanoparticles Enable Mass Production of Wearable Biosensors
The future of medicine is likely to focus on the personalization of healthcare—understanding exactly what an individual requires and delivering the appropriate combination of nutrients, metabolites, and... Read more
Business
view channel
Medtronic to Acquire Coronary Artery Medtech Company CathWorks
Medtronic plc (Galway, Ireland) has announced that it will exercise its option to acquire CathWorks (Kfar Saba, Israel), a privately held medical device company, which aims to transform how coronary artery... Read more
Medtronic and Mindray Expand Strategic Partnership to Ambulatory Surgery Centers in the U.S.
Mindray North America and Medtronic have expanded their strategic partnership to bring integrated patient monitoring solutions to ambulatory surgery centers across the United States. The collaboration... Read more
FDA Clearance Expands Robotic Options for Minimally Invasive Heart Surgery
Cardiovascular disease remains the world’s leading cause of death, with nearly 18 million fatalities each year, and more than two million patients undergo open-heart surgery annually, most involving sternotomy.... Read more