TY  - JOUR
A1  - Meybohm, Patrick
A1  - Renner, Jochen
A1  - Broch, Ole
A1  - Caliebe, Dorothee
A1  - Albrecht, Martin
A1  - Cremer, Jochen
A1  - Haake, Nils
A1  - Scholz, Jens
A1  - Zacharowski, Kai
A1  - Bein, Berthold
T1  - Postoperative neurocognitive dysfunction in patients undergoing cardiac surgery after remote ischemic preconditioning : a double-blind randomized controlled pilot study
T2  - PLoS One
N2  - Background: Remote ischemic preconditioning (RIPC) has been shown to enhance the tolerance of remote organs to cope with a subsequent ischemic event. We hypothesized that RIPC reduces postoperative neurocognitive dysfunction (POCD) in patients undergoing complex cardiac surgery.
Methods: We conducted a prospective, randomized, double-blind, controlled trial including 180 adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were randomized either to RIPC or to control group. Primary endpoint was postoperative neurocognitive dysfunction 5–7 days after surgery assessed by a comprehensive test battery. Cognitive change was assumed if the preoperative to postoperative difference in 2 or more tasks assessing different cognitive domains exceeded more than one SD (1 SD criterion) or if the combined Z score was 1.96 or greater (Z score criterion).
Results: According to 1 SD criterion, 52% of control and 46% of RIPC patients had cognitive deterioration 5–7 days after surgery (p = 0.753). The summarized Z score showed a trend to more cognitive decline in the control group (2.16±5.30) compared to the RIPC group (1.14±4.02; p = 0.228). Three months after surgery, incidence and severity of neurocognitive dysfunction did not differ between control and RIPC. RIPC tended to decrease postoperative troponin T release at both 12 hours [0.60 (0.19–1.94) µg/L vs. 0.48 (0.07–1.84) µg/L] and 24 hours after surgery [0.36 (0.14–1.89) µg/L vs. 0.26 (0.07–0.90) µg/L].
Conclusions: We failed to demonstrate efficacy of a RIPC protocol with respect to incidence and severity of POCD and secondary outcome variables in patients undergoing a wide range of cardiac surgery. Therefore, definitive large-scale multicenter trials are needed.
Trial Registration: ClinicalTrials.gov NCT00877305
Y1  - 2013
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/30101
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-301012
SN  - 1932-6203
N1  - Copyright: © 2013 Meybohm et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
VL  - 8
IS  - (5):e64743
PB  - PLoS
CY  - Lawrence, Kan.
ER  -