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Remote ischaemic preconditioning does not alter perioperative cytokine production in high-risk cardiac surgery
  1. Jenni M Williams1,
  2. Paul Young2,3,
  3. Janine Pilcher3,
  4. Mark Weatherall2–4,
  5. John Holmes Miller1,
  6. Richard Beasley2,3,
  7. Anne Camille La Flamme1
  1. 1School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
  2. 2Capital and Coast District Health Board, Wellington, New Zealand
  3. 3Medical Research Institute of New Zealand, Wellington, New Zealand
  4. 4Department of Medicine, Otago University, Wellington, New Zealand
  1. Correspondence to Dr Anne Camille La Flamme, School of Biological Sciences, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand; anne.laflamme{at}


Rationale Remote ischaemic preconditioning (RIPC) is a novel cardioprotective strategy that uses brief intermittent limb ischaemia to protect the myocardium and other organs from perioperative ischaemic damage. The precise mechanism through which this protective effect occurs is unknown, but potentially could be related to changes in blood-borne mediators such as cytokines.

Objective To determine whether RIPC alters inflammatory cytokine expression in a double-blind, randomised, controlled trial of patients undergoing high-risk cardiac surgery.

Methods and results Serum interleukin (IL)-6, IL-8, and IL-10 levels from 95 patients randomised to RIPC (n=47) or control treatment (n=48) were measured preoperatively, and 1, 2, 3, 6 and 12 h after cross-clamp removal. Systemic concentrations of all cytokines were increased from baseline following surgery, and, compared with simple procedures, complex surgeries were associated with significantly higher release of IL-6 (ratio of mean area under the curves 1.54 (95% CI 1.02 to 2.34), p=0.04) and IL-10 (1.97 (1.16 to 3.35), p=0.012). No significant difference in mean cytokine levels between the RIPC and control groups was detected at any time point, irrespective of the type of surgery undergone.

Conclusions High levels of IL-6, IL-8 and IL-10 are produced during high-risk cardiac surgery, and RIPC does not alter these elevated perioperative cytokine concentrations. Identification of factors that influence the ability to induce RIPC-mediated cardioprotection should be the priority of future research.

Trial registration is in the Australian New Zealand Clinical Trials Registry (; ACTRN12609000965202)

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