Remote ischaemic preconditioning and survival in noncardiac surgery: a meta-analysis of randomised trials

Fresilli S. Labanca R. Turi S. Casuale V. Vietri S. Lombardi G. Covello R.D. Lee T.C. Landoni G. Greco M. Lembo R. Giardina G. Nakhnoukh C. Oliva F.M. Pontillo D. Brusasco C. Roasio A. Konkayev A. Lei C. Yavorovskiy A. Likhvantsev V.
May 2025 Elsevier Ltd

British Journal of Anaesthesia
2025 #134 Issue 5 1373 - 1384 pp.

Background: Remote ischaemic preconditioning (RIPC) is an intervention involving brief periods of limb ischaemia to protect remote organs from subsequent ischaemic injury. Although evidence exists on the beneficial effects of RIPC on biomarkers, its effect on survival is unknown. We performed a meta-analysis of randomised controlled trials (RCTs) to evaluate whether RIPC improves survival in noncardiac surgery. Methods: We searched several electronic databases for randomised trials comparing RIPC vs a control group in adult noncardiac surgical settings. The primary outcome was mortality at the longest follow-up available. We conducted a random-effects meta-analysis to calculate the risk ratio (RR) and 95% confidence intervals (CIs). Bayesian statistics were used to estimate the probability of mortality benefit (RR <1). Results: We identified 72 RCTs, which included 7457 subjects. Mortality was reported in 28 RCTs and was lower in the RIPC group compared with the control group (88/2122 [4.1%] vs 102/1767 [5.8%]; RR 0.74, 95% CI 0.57–0.98, P=0.03; I²=0%; moderate certainty; number needed to treat = 67), corresponding to a 97.0% probability of any reduction in mortality. RIPC was also associated with a reduced incidence of postoperative stroke (moderate certainty) and with a shorter duration of hospital stay (low certainty). Conclusions: Remote ischaemic preconditioning was associated with improved survival and reduced postoperative stroke and hospital stay in noncardiac surgery. These findings warrant careful considerations of the benefits of RIPC and support the need for a large, multicentre RCT to confirm these promising results. Systematic review protocol: CRD42024588358 (PROSPERO).

acute kidney injury , anaesthesia , meta-analysis , mortality , noncardiac surgery , organ protection , remote ischaemic preconditioning (RIPC)

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Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
Anesthesia and Intensive Care Unit, Emergency Department, Busto Arsizio Hospital, ASST Valle Olona, Busto Arsizio, Italy
Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, QC, Canada
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Italy
Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy
Anaesthesia and Intensive Care Unit, Cardinal Massaia Hospital, Asti, Italy
Astana Medical University, Astana, Kazakhstan
National Scientific Center of Traumatology and Orthopedia named acad NBatpenov, Astana Medical University, Astana, Kazakhstan
Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Xian, China
Department of Anaesthesiology and Intensive Care, I.M. Sechenov First Moscow State Medical University of the Russian Ministry of Health, Moscow, Russian Federation
V. Negovsky Reanimatology Research Institute, Moscow, Russian Federation

Department of Anaesthesia and Intensive Care
School of Medicine
Anesthesia and Intensive Care Unit
Division of Infectious Diseases
Department of Biomedical Sciences
Department of Anesthesiology and Intensive Care
Anaesthesia and Intensive Care Unit
Anaesthesia and Intensive Care Unit
Astana Medical University
National Scientific Center of Traumatology and Orthopedia named acad NBatpenov
Department of Anaesthesiology and Perioperative Medicine
Department of Anaesthesiology and Intensive Care
V. Negovsky Reanimatology Research Institute

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