The clinical value of remote ischemic conditioning in patients with severe traumatic brain injury: A multicenter prospective study

Objective: This study investigated the clinical effect of remote ischemic conditioning (RIC) in patients with severe traumatic brain injury (sTBI). Methodology: This was the multicenter, double-blind, randomized, placebo-controlled trial, conducted across three hospitals (Wuxi Xishan Hospital, 904th Hospital of Joint Logistic Support Force, and the Affiliated Huishan Hospital of Xinglin College) in China. Enrollment occurred from May 1, 2022, to December 31, 2024, with a 180 days follow-up period for all participants. A total of 340 patients with sTBI who were diagnosed and admitted to the Department of Neurosurgery. A computerized random grouping program was used to divide them into an RIC group (conventional therapy+ RIC treatment) of 170 patients and a control group (conventional therapy) of 170 patients with a course of 14 days. The primary outcome was the extended Glasgow Outcome Scale (GOSE) score at six months, and the secondary outcomes were 30-day all-cause mortality, cerebral infarction, delayed ischemic neurological deficit, and the rate of adverse events. Results: After the 6-month follow-up, the RIC group had a significantly greater proportion of patients with a GOSE score of five to eight than the control group (p = 0.016). And, also significant improvements in posttraumatic cerebral infarction (PTCI, p = 0.017), brain swelling (0.038) and ischemic stroke (p = 0.032). No difference in 30 days all-cause mortality (p = 0.330) or hematoma enlargement (p = 0.320). Conclusion: RIC treatment seems to be associated with neurological improvement and decreases in the incidence of ischemic stroke, PTCI, and brain swelling without increasing the risk of intracranial hemorrhage or serious adverse events in sTBI patients, and worthy of application and promotion.