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BMJ. 2007 September 1; 335(7617): 421.
PMCID: PMC1962843
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Preoperative ischaemia of the arm reduces heart muscle injury during bypass surgery

Remote ischaemic preconditioning, first described in 1993, refers to a technique where one tissue's or organ's damage from ischaemia is reduced as a consequence of ischaemia in a distant tissue or organ. The mechanism of action is unclear, but previous studies found that cross clamping of the aorta reduced damage to the heart muscle during coronary artery bypass surgery.

A proof of concept study has found similar results with a simpler procedure—three preoperative cycles of five minutes' ischaemia of the arm, interrupted by five minute reperfusion periods—induced by inflating an upper arm cuff to 200 mm Hg or deflating it. Perioperative concentrations of troponin T, a serum marker of subtle myocardial injury associated with worse short term and long term outcomes, were reduced in the intervention group at 6, 12, 24, and 48 hours after surgery. The total area under the curve for serum concentration of troponin T was reduced by 43% (P=0.005).

The linked comment (p 542) says the implications for practice could be immense if these results are repeated in larger multicentre trials, in more heterogeneous populations of people undergoing coronary artery bypass surgery, and with confirmed benefits for clinical outcomes.


  • Lancet 2007;370:575-9 [PubMed]

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