Remote preconditioning and major clinical complications following adult cardiovascular surgery: Systematic review and meta-analysis

Ischaemic conditioning: are we there yet?

“…The reasons for this discrepancy are not clear but may relate to the following factors: patient selection (CABG vs valve surgery, patients with stable vs unstable IHD); timing of the limb RIC protocol (prior to vs after surgical incision); blinding of the RIC protocol (proper vs limited blinding); the intensity of the RIC protocol (three vs four cycles of limb RIC and inflation of cuff to 200 mm Hg vs 15 mm Hg above systolic blood pressure); and the presence of confounding factors (table 5). The results of several recent meta-analyses have confirmed the cardioprotective effects of RIC in this clinical setting in terms of attenuating PMI 40 41. The ongoing RIPHeart42 and ERICCA43 multicentre clinical trials, which are currently investigating the effect of RIC on clinical outcomes post cardiac bypass surgery (table 1), should hopefully provide definitive evidence of the cardioprotective effects of RIC in this clinical setting.…”

Cell cycle arrest biomarkers for the early prediction of acute kidney injury - full of promise, but not a must–have for yet

“…RIP had no significant effect on myocardial infarction, stroke or mortality, but was associated with a significant reduction in AKI, less RRT and shorter ICU stay, as well as a significant attenuation in the release of IGFBP 7 and TMP-2 after surgery (28). Schiffl H et al In contrast, a meta-analysis including 2200 study patients, found no significant difference in postoperative kidney function (serum creatinine or GFR,), incidence of RRT, or hospital mortality , and hospital or ICU stay in patients receiving RIP (29). Thus, adequately powered trials are needed to prove the evidence of a beneficial effect of RIP for prevention of post-cardiac surgery AKI.…”

Renal Failure and Heart Surgery

“…A list of attempted and failed strategies to prevent CSA-AKI includes:diuretics (furosemide, mannitol) [29]; renal vasodilators (dopamine, fenoldopan, Ca channel blockers); atrial natriuretic peptides (nesiritide); anti-oxidants (N-acetylcysteine); ACE-inhibitors [30]; anti-inflammatory drugs (steroids); ultrafiltration; anti-apoptotic agents; urinary alkalinization by sodium bicarbonate [31]; statins [32]; human recombinant erythropoietin [33]; and remote ischemic pre conditioning [34]. Trials conducted on renotropic progenitor cells administration were prematurely terminated by the company (AlloCure).…”