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Remote ischaemic preconditioning protects against cardiopulmonary bypass-induced tissue injury: a preclinical study
  1. R K Kharbanda1,
  2. J Li2,
  3. I E Konstantinov2,
  4. M M H Cheung2,
  5. P A White3,
  6. H Frndova2,
  7. J Stokoe2,
  8. P Cox2,
  9. M Vogel4,
  10. G Van Arsdell2,
  11. R MacAllister4,
  12. A N Redington2
  1. 1University of Cambridge, Cambridge, UK
  2. 2The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3Papworth Hospital, Cambridge, UK
  4. 4University College London, London, UK
  1. Correspondence to:
    Rajesh K Kharbanda
    Harefield Hospital, Hill End Road, Uxbridge UB9 6JH, UK; r.kharbanda{at}


Objectives: To test the hypothesis that remote ischaemic preconditioning (rIPC) reduces injury after cardiopulmonary bypass (CPB).

Design: Randomised study with an experimental model of CPB (3 h CPB with 2 h of cardioplegic arrest). Twelve 15 kg pigs were randomly assigned to control or rIPC before CPB and followed up for 6 h.

Intervention: rIPC was induced by four 5 min cycles of lower limb ischaemia before CPB.

Main outcome measures: Troponin I, glial protein S-100B, lactate concentrations, load-independent indices (conductance catheter) of systolic and diastolic function, and pulmonary resistance and compliance were measured before and for 6 h after CPB.

Results: Troponin I increased after CPB in both groups but during reperfusion the rIPC group had lower concentrations than controls (mean area under the curve −57.3 (SEM 7.3) v 89.0 (11.6) ng·h/ml, p  =  0.02). Lactate increased after CPB in both groups but during reperfusion the control group had significantly more prolonged hyperlactataemia (p  =  0.04). S-100B did not differ between groups. Indices of ventricular function did not differ. There was a tendency to improved lung compliance (p  =  0.07), and pulmonary resistance changed less in the rIPC than in the control group during reperfusion (p  =  0.02). Subsequently, peak inspiratory pressure was lower (p  =  0.001).

Conclusion: rIPC significantly attenuated clinically relevant markers of myocardial and pulmonary injury after CPB. Transient limb ischaemia as an rIPC stimulus has potentially important clinical applications.

  • avDo2, arteriovenous oxygen content difference
  • CPB, cardiopulmonary bypass
  • DC, direct current
  • Fextr, extrapolated maximum flow at the beginning of the exhalation
  • IR, ischaemia–reperfusion
  • Poccl, pressure signal during occlusion
  • PVR, pulmonary vascular resistance
  • rIPC, remote ischaemic preconditioning
  • Vextr, extrapolated exhaled volume
  • o2, oxygen consumption

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  • This work was supported by a grant from the Canadian Institutes of Health Research. The British Heart Foundation supports RKK. MMHC is supported by the Heart and Stroke Foundation of Ontario, Canada