Remote ischemic preconditioning and clinical outcomes after pediatric cardiac surgery: a systematic review and meta-analysis

Abstract

Background The benefit of remote ischemia preconditioning (RIPreC) in pediatric cardiac surgery is unclear. The objective of this systematic review and meta-analysis was to examine the effectiveness of RIPreC in reducing the duration of mechanical ventilation and intensive care unit (ICU) length of stay after pediatric cardiac surgery. Methods We searched PubMed, EMBASE and the Cochrane Library from inception to December 31, 2022. Randomized controlled trials comparing RIPreC versus control in children undergoing cardiac surgery were included. The risk of bias of included studies was assessed using the Risk of Bias 2 (RoB 2) tool. The outcomes of interest were postoperative duration of mechanical ventilation and ICU length of stay. We conducted random-effects meta-analysis to calculate weighted mean difference (WMD) with 95% confidence interval (CI) for the outcomes of interest. We performed sensitivity analysis to examine the influence of intraoperative propofol use. Results Thirteen trials enrolling 1,352 children were included. Meta-analyses of all trials showed that RIPreC did not reduce postoperative duration of mechanical ventilation (WMD -5.35 h, 95% CI -12.12–1.42) but reduced postoperative ICU length of stay (WMD -11.48 h, 95% CI -20.96– -2.01). When only trials using propofol-free anesthesia were included, both mechanical ventilation duration (WMD -2.16 h, 95% CI -3.87– -0.45) and ICU length of stay (WMD -7.41 h, 95% CI -14.77– -0.05) were reduced by RIPreC. The overall quality of evidence was moderate to low. Conclusions The effects of RIPreC on clinical outcomes after pediatric cardiac surgery were inconsistent, but both postoperative mechanical ventilation duration and ICU length of stay were reduced in the subgroup of children not exposed to propofol. These results suggested a possible interaction effect of propofol. More studies with adequate sample size and without intraoperative propofol use are needed to define the role of RIPreC in pediatric cardiac surgery.

The Protective Effect of Remote Ischemic Preconditioning on Acute Kidney Injury Following Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis

“…These variations may also lead to observed heterogeneity. For instance, signi cant reductions in the duration of mechanical ventilation and ICU stay were observed in trials that did not use propofol, which suggests that propofol may interfere with the protective effects of RIPC [20] . 3.…”

A Year of Changes: The End of the Pandemic Marks the Beginning of New Priorities

“…In a meta-analysis, remote ischemic preconditioning reduced postoperative mechanical ventilation and duration of ICU length of stay with propofolfree anesthesia. 36 Notably, an observational trial assessing neurodevelopment in infants undergoing surgery with CPB showed an association between higher ketamine doses and worse motor development at 18 months of age. 37 In a retrospective study by Fragasso et al, an AI-based algorithm utilizing 36 variables predicted postoperative AKI in children undergoing cardiac surgery with high accuracy.…”