Remote Ischemic Preconditioning Fails to Benefit Pediatric Patients Undergoing Congenital Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Hong-Tao Tie, Ming-Zhu Luo, Zhen-Han Li, Qian Wang, Qing-Chen Wu, Qiang Li, Min Zhang, Hong-Tao Tie, Ming-Zhu Luo, Zhen-Han Li, Qian Wang, Qing-Chen Wu, Qiang Li, Min Zhang

Abstract

Remote ischemic preconditioning (RIPC) has been proven to reduce the ischemia-reperfusion injury. However, its effect on children receiving congenital cardiac surgery (CCS) was inconsistent. We therefore performed the current meta-analysis of randomized controlled trials (RCTs) to comprehensively evaluate the effect of RIPC in pediatric patients undergoing CCS.PubMed, Embase, and Cochrane library were searched to identify RCTs assessing the effect of RIPC in pediatric patients undergoing CCS. The outcomes included the duration of mechanical ventilation (MV), intensive care unit (ICU) length of stay, postoperative cardiac troponin (cTnI) level, hospital length of stay (HLOS), postoperative inotropic score, and mortality. Subgroup and sensitivity analysis were also performed as predesigned. The meta-analysis was performed with random-effects model despite of heterogeneity. Sensitivity and subgroup analysis were predesigned to identify the robustness of the pooled estimate.Nine RCTs with 697 pediatric patients were included in the meta-analysis. Overall, RIPC failed to alter clinical outcomes of duration of MV (standard mean difference [SMD] -0.03, 95% confidence interval [CI] -0.23-0.17), ICU length of stay (SMD -0.22, 95% CI -0.47-0.04), or HLOS (SMD -0.14, 95% CI -0.55-0.26). Additionally, RIPC could not reduce postoperative cTnI (at 4-6 hours: SMD -0.25, 95% CI -0.73-0.23; P = 0.311; at 20-24 hours: SMD 0.09, 95% CI -0.51-0.68; P = 0.778) or postoperative inotropic score (at 4-6 hours: SMD -0.19, 95% CI -0.51-0.14; P = 0.264; at 24 hours: SMD -0.15, 95% CI -0.49-0.18; P = 0.365).RIPC may have no beneficial effects in children undergoing CCS. However, this finding should be interpreted with caution because of heterogeneity and large-scale RCTs are still needed.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Study identification of the included RCTs. cTnI = cardiac troponin, HLOS = hospital length of stay, ICU = intensive care unit, MV = mechanical ventilation, RCT = randomized controlled trial.
FIGURE 2
FIGURE 2
(A) Forest plots for the effect of RIPC on the duration of MV. (B) Forest plots for the effect of RIPC on ICU length of stay. (C) Forest plots for the effect of RIPC on HLOS. ICU = intensive care unit, HLOS = hospital length of stay, MV = mechanical ventilation, RIPC = remote ischemic preconditioning, SMD = standard mean difference.
FIGURE 3
FIGURE 3
(A) Forest plots for the effect of RIPC on cTnI at postoperative 4 to 6 hours. (B) Forest plots for the effect of RIPC on cTnI at postoperative 20 to 24 hours. cTnI = cardiac troponin, RIPC = remote ischemic preconditioning, SMD = standard mean difference.
FIGURE 4
FIGURE 4
(A) Forest plots for the effect of RIPC on inotropic score at postoperative 4 to 6 hours. (B) Forest plots for the effect of RIPC on inotropic score at postoperative 24 hours. RIPC = remote ischemic preconditioning, SMD = standard mean difference.

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Source: PubMed

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