Key result
Remote ischaemic preconditioning probably leads to little or no difference in perioperative mortality compared with no preconditioning in patients undergoing major vascular and endovascular surgery.
Why the study?
Elective major vascular surgical procedures carry significant morbidity and mortality risks, but the efficacy and safety of remote ischaemic preconditioning in this setting remain unknown.
Does remote ischaemic preconditioning reduce perioperative mortality in people undergoing elective major vascular and endovascular surgery?
Systematic Review (n=803)
Does remote ischaemic preconditioning reduce perioperative mortality in people undergoing elective major vascular and endovascular surgery?
Remote ischaemic preconditioning does not provide significant clinical benefit in reducing perioperative mortality or morbidity during elective major vascular surgery.
No mortality benefit from remote ischaemic preconditioning in major vascular surgery; confirms null effect across RCTs.
BACKGROUND: Despite advances in perioperative care, elective major vascular surgical procedures still carry a significant risk of morbidity and mortality. Remote ischaemic preconditioning (RIPC) is the temporary blocking of blood flow to vascular beds remote from those targeted by surgery. It has the potential to provide local tissue protection from further prolonged periods of ischaemia. However, the efficacy and safety of RIPC in people undergoing major vascular surgery remain unknown. This is an update of a review published in 2011. OBJECTIVES: To assess the benefits and harms of RIPC versus no RIPC in people undergoing elective major vascular and endovascular surgery. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov to 1 April 2022. SELECTION CRITERIA: We included all randomised controlled trials that evaluated the role of RIPC in reducing perioperative mortality and morbidities in people undergoing elective major vascular or endovascular surgery. DATA COLLECTION AND ANALYSIS: We collected data on the characteristics of the trial, methodological quality, and the remote ischaemic preconditioning stimulus used. Our primary outcome was perioperative mortality, and secondary outcomes included myocardial infarction, renal impairment, stroke, hospital stay, limb loss, and operating time or total anaesthetic time. We analysed the data using random-effects models. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) based on an intention-to-treat analysis. In addition, we used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: = 44%; 10 studies, 803 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Overall, compared with no RIPC, RIPC probably leads to little or no difference in perioperative mortality, myocardial infarction, renal impairment, stroke, hospital stay, and operating time, and may lead to little or no difference in limb loss in people undergoing elective major vascular and endovascular surgery. Adequately powered and designed randomised studies are needed, focusing in particular on the clinical endpoints and patient-centred outcomes.
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Liang et al. (2023) conducted a systematic review in elective major vascular and endovascular surgery (n=803). Remote ischaemic preconditioning (RIPC) vs. no RIPC was evaluated on perioperative mortality. Remote ischaemic preconditioning probably leads to little or no difference in perioperative mortality compared with no preconditioning in patients undergoing major vascular and endovascular surgery.
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