Adjunctive remote ischaemic postconditioning and hypothermia therapy in acute encephalopathy with biphasic seizures.

BACKGROUND: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a common form of acute infection-triggered encephalopathy in children. This study aimed to evaluate the safety and feasibility of remote ischaemic postconditioning (RIPoC) as an adjunct to therapeutic hypothermia in patients with AESD. METHODS: In this prospective, non-randomised study, patients treated in January 2021-July 2024 were compared with a historical control group treated in January 2017-December 2020. RIPoC (four cycles of 5-min inflation and 5-min deflation) was applied to the lower extremity at the initiation of therapeutic hypothermia. Adverse events were assessed between the RIPoC group (n = 15) and patients with therapeutic hypothermia in the control groups (n = 12). Neurological outcomes at 6-18 months post-onset were compared between the RIPoC group (n = 12) and patients with/without therapeutic hypothermia in the control groups (n = 13). Multivariate analyses were performed to identify predictors of favourable neurological outcomes. RESULTS: While the comparison of adverse events and neurological outcomes between groups did not show significant differences, multiple analysis suggested associations between a lower Tada score or RIPoC treatment and better outcomes. CONCLUSION: RIPoC combined with therapeutic hypothermia appears safe and feasible in patients with AESD. IMPACT: Remote ischaemic postconditioning (RIPoC) was safely combined with hypothermia in paediatric patients with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD). No coagulation, hemodynamic complications, or adverse events were observed. Multiple linear regression analysis suggested associations between a lower Tada score or RIPoC treatment and better outcomes in patients with AESD. This is the first report to examine the feasibility and safety of the RIPoC in paediatric central nervous system disease not directly related to ischaemia-reperfusion injury. Findings support future randomised controlled studies to confirm RIPoC as a possible adjunctive neuroprotective therapy in paediatric brain injury, particularly AESD.