Key result
RIPOST-CA trial evaluates early remote ischemic post-conditioning to reduce brain injury after cardiac arrest.
Why the study?
Hypoxic-ischaemic brain injury after out-of-hospital cardiac arrest is driven by ischaemia–reperfusion syndrome, for which no specific treatment exists.
Does early remote ischaemic post-conditioning reduce hypoxic-ischaemic brain injury biomarkers in comatose adults resuscitated from out-of-hospital cardiac arrest?
RCT (n=48)
Single-blind
1:1
No
Does early remote ischaemic post-conditioning reduce hypoxic-ischaemic brain injury biomarkers in comatose adults resuscitated from out-of-hospital cardiac arrest?
The RIPOST-CA trial protocol outlines the first randomized evaluation of early remote ischemic post-conditioning on brain-injury biomarkers in comatose patients after out-of-hospital cardiac arrest.
First RCT testing remote ischaemic post-conditioning on biomarkers after OHCA; leaves open clinical efficacy and warrants larger outcome trials.
Introduction Hypoxic-ischaemic brain injury is the leading cause of death and long-term disability after out-of-hospital cardiac arrest and is driven by the ischaemia–reperfusion syndrome, for which no specific treatment exists. Remote ischaemic post-conditioning (brief, repeated cycles of limb ischaemia and reperfusion delivered with a pneumatic cuff), is protective across ischemia-reperfusion conditions. We aim to assess whether early conditioning reduces hypoxic-ischaemic brain injury after out-of-hospital cardiac arrest. Methods This single-centre, single-blinded, randomised (1:1) controlled trial with blinded assessment of the outcome, enrols 48 comatose adults resuscitated from out-of-hospital cardiac arrest. Participants receive standard post-resuscitation care with three sham cuff sessions, or standard care plus three sessions of conditioning (thigh cuff, four cycles of 5-min inflation at 200 mmHg alternating with 5-min deflation), the first within 4 hours of return of spontaneous circulation and repeated at the 12 th and 24 th hour. Randomisation is stratified by initial rhythm (shockable versus non-shockable). The primary endpoint is the change in serum neurofilament light chain between the 6 th and 72 nd hour after return of spontaneous circulation. Secondary endpoints include daily Sequential Organ Failure Assessment scores (days 1–3), serum neuron-specific enolase and protein S100-B kinetics, in-intensive care unit mortality by cause, and a favourable neurological outcome (modified Rankin Scale 0–3) at intensive care unit discharge and at 90 days. Conclusion RIPOST-CA is the first randomised trial to evaluate early remote ischemic post-conditioning on brain-injury biomarkers after out-of-hospital cardiac arrest. Its results could inform larger clinical trials of this simple, non-invasive intervention. Trial registration number: NCT06473207
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Chelly et al. (2026) conducted an RCT in Out-of-hospital cardiac arrest (n=48). Remote ischaemic post-conditioning vs. Standard post-resuscitation care with three sham cuff sessions was evaluated on Change in serum neurofilament light chain between the 6th and 72nd hour after return of spontaneous circulation. RIPOST-CA is a randomized trial protocol designed to evaluate the effect of early remote ischemic post-conditioning on brain-injury biomarkers in 48 comatose adults after cardiac arrest.
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