Application of remote ischaemic preconditioning to human coronary artery bypass surgery

This thesis reports a clinical study designed to assess myocardial, renal and lung outcomes following cardiac surgery. In a single centre, prospective randomized, placebo intervention-controlled trial the effects of intermittent upper limb ischaemia (remote ischaemic preconditioning (RIPC)) were compared in non-diabetic adult patients undergoing on-pump multi-vessel coronary artery surgery. Patients, investigators, anaesthetists, surgeons and critical care teams were all blind to group allocation. Subjects were randomized(1:1) to RIPC(or placebo) stimuli (3x upper limb (or dummy arm) 5 minute cycles of 200mmHg cuff inflation/deflation) during sternotomy and conduit procurement. Anaesthesia, perfusion, cardioplegia and surgical techniques were standardized. Groups were well matched on demographic and operative variables. In contrast to prior smaller studies, RIPC did not reduce troponin T (48 hour area under the curve (AUC); 6hour and peak) release, improve post-operative haemodynamics (cardiac indices; low cardiac output episodes incidence; IABP usage; inotrope and vasoconstrictor use; M mode, 2D contrastenhanced echocardiography and tissue Doppler imaging) or offer antiarrhythmic benefit (de novo left bundle branch block or Q waves; ventricular tachyarrhythmia incidence). RIPC did not afford renal (peak creatinine, AUC urinary albumin-creatinine ratios, dialysis requirement) or lung protection (intubation times, 6hour and 12 hour pO2/FiO2 ratios). Case urgency did not influence RIPC effect.

Name dc:type.qualificationname

h_md

Level dc:type.qualificationlevel

h_md

Grantor dc:publisher.institution

University of Birmingham

Year dc:date.issued

2010

Author dc:creator

• Rahman, Ishtiaq Ali

• R Medicine (General)
• RD Surgery
• RC Internal medicine