[3] The procedure involves repeated, temporary cessation of blood flow to a limb to create ischemia (lack of oxygen and glucose) in the tissue.
[9] Other researchers confirmed this remote effect and found that performing the preconditioning protocol on kidney or gastrointestinal tissue also provided protection to the heart.
[10] In 2002, Raj Kharbanda and Andrew Redington, working at the Hospital for Sick Children in Toronto, showed that non-invasively stopping and starting blood flow in the arm provided the same protection as invasive preconditioning of the heart.
[citation needed] The first human clinical trial of RIC was conducted by Dr. Redington in pediatric patients undergoing heart surgery at the Hospital for Sick Children.
[citation needed] Infarct size is a predictor of future cardiovascular events as well as mortality,[23] and researchers doing long-term follow-up on STEMI patients treated with RIC found that the reduction in heart damage at the time of the heart attack resulted in clinical improvement four years later: MACCE (major adverse cardiovascular and cerebrovascular event) rates were reduced by 47% (13.5% vs. 25.6%, p=0.018).
[citation needed] Remote ischemic conditioning significantly reduced heart damage (as measured by troponin elevations) in four randomized controlled trials involving 816 elective (non-emergency) PCI patients.
In a viewpoint letter that followed the publication of the ERICCA and RIP-HEART trials, Heusch and Dr. Bernard Gersh wrote that the use of propofol rather than volatile anesthesia appeared to be a common denominator in all studies that failed to find protection with RIC.
[54][55] The acute inflammatory process that occurs soon after a heart attack is necessary for healing and scar formation,[56] but can be harmful if it continues for an extended period of time.
Studies show that repeated daily RIC treatments lead to significant downregulation of neutrophil activation and proinflammatory responses in humans,[58] and could reduce post-heart-attack inflammation.
In addition to its efficacy in cardiological settings, RIC is thought to remotely recruit neuroprotective pathways, and its safety, feasibility, and low cost give it high potential in a wide variety of neurological conditions.
The second trial examined the effect of 180 days of RIC on symptomatic ICAS in Chinese people aged 80–95 years, as invasive stenting is not always suitable for elderly patients, and less-invasive methods are needed.
A small randomized clinical trial in severe TBI also showed that patients who received RIC had lower levels of brain injury biomarkers.
Cardiovascular risk factor control is currently the only management option for VCI, but observational studies suggest that exercise slows down cognitive decline.
[71] In laparoscopic procedures, CO2 pneumoperitoneum is essential for adequate visualization but can lead to elevated intra-abdominal pressure, potentially causing splanchnic hypoperfusion and capillary microcirculation impairment.
This scenario predisposes to ischemia-reperfusion injury, characterized by an upsurge in reactive oxygen species (ROS), culminating in a spectrum of peritoneal pathologies, including mesothelial cell damage, inflammatory cascades, and adhesion formation.
In vitro and in vivo studies elucidate that IPC augments cellular anti-oxidative defenses and modulates inflammatory mediators, potentially attenuating peritoneal injury sequelae.
Notably, a study involving remote ischemic conditioning applied to the upper arm exhibited enhanced skin microcirculation in the lower extremities, suggesting systemic microcirculatory benefits.
[74] Furthermore, in a trial involving patients undergoing laparoscopic surgery, those subjected to IPC demonstrated notable improvements in systemic antioxidant capacity, as evidenced by elevated glutathione levels.
[75] These findings, while preliminary, underscore IPC's promise in laparoscopic surgery, suggesting its role in reducing oxidative stress and improving postoperative outcomes.