Remote Ischemic Preconditioning has a Cardioprotective Effect in Children in the Early Postoperative Phase: A Meta-Analysis of Randomized Controlled Trials

Abstract

In this updated meta-analysis, we assessed the cardioprotective effect of remote ischemic preconditioning (RIPC) in pediatric patients undergoing congenital heart surgery. A total of 9 randomized controlled trials (RCTs) involving 793 pediatric patients under 18 years old were identified. RIPC obviously reduced the release of troponin I at 6 h after surgery [standard mean difference (SMD) -0.59, 95% confidence interval (CI) -1.14 to -0.04; p = 0.03], mitigated the inotropic scores within 4-6 h (SMD -0.43, 95% CI -0.72 to -0.14; p = 0.004) and within 12 h (SMD -0.26, 95% CI -0.50 to -0.02; p = 0.03) and shortened the ventilator support time (SMD -0.28, 95% CI -0.49 to -0.07; p = 0.01) as well as the duration of intensive care unit (ICU) stay (SMD -0.21, 95% CI -0.35 to -0.06; p = 0.004). Our meta-analysis determined that RIPC had cardioprotective effects in the early postoperative phase. Additional RCTs focused on the cardiac benefits from RIPC in pediatric patients are warranted.

Effect of remote ischemic preconditioning on lung function after surgery under general anesthesia: A systematic review and meta-analysis

“…Likewise, Min et al reported that RIPC reduced the incidence of MV > 48 hours after cardiac surgery. 8 Similarly to past studies 70,71 , the present analysis showed that RIPC was associated with a slightly shorter duration of MV (1 hour). Our analysis also showed high heterogeneity (I 2 = 84%), which was not explained by a sub-group analysis strati ed by age or anesthetic regimen.…”

The Bilateral Remote Ischaemic Conditioning in Children (BRICC) trial: a two-centre, double-blind, randomised controlled trial in young children undergoing cardiac surgery

“…A meta-analysis suggested that RIPC reduces myocardial injury during cardiac surgery [32], but subsequently two large multi-centre trials in adults failed to show benefit in either composite cardiovascular endpoints or troponin release [30,31]; both were criticised for using propofol anaesthesia after it had been shown to interfere with the preconditioning pathway [16,17]. In a more recent meta-analysis in children, including 793 patients in 9 trials, Tan et al determined that RIPC has a cardioprotective effect, with reduced troponin release at 6 hours, lower inotrope scores in the first 12 hours, and reduced PICU stay following surgery [33]; however they were unable to include the only large trial in most analyses due to a lack of suitable published data. Our trial makes an important contribution to the literature, raising significant doubts about the use of RIPC in paediatric cardiac surgery.…”

Remote ischemic preconditioning-induced late cardioprotection: possible role of melatonin-mitoKATP-H2S signaling pathway

“…However, RIPC attenuated ischemia-reperfusion-induced rise in LDH-1 and cTnT and decline in LVDP, which suggests its cardioprotective effects. RIPC has been shown to produce immediate as well as delayed cardioprotective effects 20 , 21 . In this study, the delayed cardioprotective effects of RIPC were assessed and the present study results were similar to previously published reports on RIPC 22 .…”