Effect of remote ischaemic preconditioning on mortality and morbidity after non-cardiac surgery: meta-analysis

Abstract

Background Remote ischaemic preconditioning (RIPC) has been shown to have a protective role on vital organs exposed to reperfusion injury. The aim of this systematic review was to evaluate the effects of non-invasive RIPC on clinical and biochemical outcomes in patients undergoing non-cardiac surgery Methods A systematic literature search of PubMed, EMBASE, Scopus, and Cochrane databases was carried out in February 2020. RCTs investigating the effect of non-invasive RIPC in adults undergoing non-cardiac surgery were included. Meta-analyses and trial sequential analyses (TSAs) were performed on cardiovascular events, acute kidney injury, and short- and long-term mortality. Results Some 43 RCTs including 3660 patients were included. The surgical areas comprised orthopaedic, vascular, abdominal, pulmonary, neurological, and urological surgery. Meta-analysis showed RIPC to be associated with fewer cardiovascular events in non-cardiac surgery (13 trials, 1968 patients, 421 events; odds ratio (OR) 0.68, 95 per cent c.i. 0.47 to 0.96; P = 0.03). Meta-analyses of the effect of RIPC on acute kidney injury (12 trials, 1208 patients, 211 events; OR 1.14, 0.78 to 1.69; P = 0.50; I2 = 9 per cent), short-term mortality (7 trials, 1239 patients, 65 events; OR 0.65, 0.37 to 1.12; P = 0.12; I2 = 0 per cent), and long-term mortality (4 trials, 1167 patients, 9 events; OR 0.67, 0.18 to 2.55; P = 0.56; I2 = 0 per cent) showed no significant differences for RIPC compared with standard perioperative care in non-cardiac surgery. However, TSAs showed that the required information sizes have not yet been reached. Conclusion Application of RIPC to non-cardiac surgery might reduce cardiovascular events, but not acute kidney injury or all-cause mortality, but currently available data are inadequate to confirm or reject an assumed intervention effect.

Analysis of Risk Factors for Perioperative Acute Kidney Injury and Management Strategies

“…Hausenloy et al (125) included a controlled study of a total of 1,612 patients undergoing cardiac surgery in 30 centers with an observation period of 12 months and showed that the difference in the incidence of major endpoint events between patients in the remote ischemic preadaptation and control groups was not statistically significant, including the incidence of AKI, duration of ICU care, and length of hospital stay. More recently, data from a meta-analysis on 3,660 patients in 43 RCTs show a similar conclusion that remote ischemic preadaptation reduced cardiovascular events after non-cardiac surgery, but had no significant advantage for the incidence of AKI and all-cause mortality (126). Therefore, further studies are still needed to collect relevant evidence and validate the specific effect of remote ischemic preadaptation in perioperative AKI prevention.…”

Effect of Remote Ischaemic Preconditioning on Perioperative Endothelial Dysfunction in Non-Cardiac Surgery: A Randomised Clinical Trial

“…Furthermore, RIPC has been shown to reduce myocardial injury in non-cardiac surgery [ 28 ]. The mechanisms of RIPC are not fully understood despite decades of experimental and clinical research [ 29 , 30 ]. RIPC activates both a neuronal and a humoral response, as well all exerts systemic effects.…”

Remote ischemic preconditioning in patients undergoing cardiac surgery with six ischemic cycles

“…However, after initial clinical results were promising, 2 two large, prospective randomized trials 3,4 demonstrated that RIP does not lead to better outcomes in cardiac surgery regarding hard endpoints like death, stroke, or renal insufficiency. [5][6][7] Because several clinical studies failed to show success of RIP, we wanted to find out whether the "RIP doses", usually consisting of four cycles, was right. We therefore increased the number of cycles from four to six.…”