Post-remote Ischaemic Conditioning for Emergency Management of Acute-Coronary-Syndrome and Stroke?

2.50
Hdl Handle:
http://hdl.handle.net/10755/162363
Type:
Presentation
Title:
Post-remote Ischaemic Conditioning for Emergency Management of Acute-Coronary-Syndrome and Stroke?
Abstract:
Post-remote Ischaemic Conditioning for Emergency Management of
Acute-Coronary-Syndrome and Stroke?
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Black, Simon, RN, PhD, Grad Dip Advanced Nursing (Emergency), BB
P.I. Institution Name:Division of Nursing and Midwifery, La Trobe University
Title:Lecturer
Contact Address:Division of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, Bundoora, Victoria, 3073, Australia
Contact Telephone:03 9479 5609
[ENA Annual Conference - Research Presentation]

Purpose: Post-ischaemic remote conditioning (pRIC) reduced infarction volume. Limited data is available for recommending pRIC into guidelines for acute coronary syndrome (ACS) or stroke (S). Study aim was to review remote ischaemic conditioning (RIC) data for informing a position statement on use of RIC in ACS and S.

Design: Systematic-review utilizing PubMed and ClinicalTrials.gov. Inclusion criteria included clearly described randomization and patient flow, and post-treatment troponin or creatine kinase (CK) levels suitable for calculating percentage difference of enzyme leakage.

Setting: Review conducted in an Australian university school of nursing.

Participants/Subjects: Six studies meet selection criteria involving heterogeneous patients who received RIC for elective procedures: one study reported on 37 children (1.6 +/- 2.2 years) with congenital cardiac disease, and five adult patients without renal, hepatic or pulmonary disease studies (66.25 +/- 8.75 years), who under went abdominal aortic aneurysm repair (one study, n=82), coronary artery bypass surgery (two studies, n=103), or percutaneous coronary intervention (two studies, n=283). Six studies (n=244) were identified that evaluated the impact of post-ischaemic intra-coronary conditioning (PIICC) on ACS. More than 50% of participants were male. All reviewed studies had been approved by local ethics committees.

Methods: Details of patients, randomization, sample size/power analysis, conditioning protocol and outcome measures were tabulated for comparison. The 24 hour level of serum troponin or CK was used to compare the treatment effect of ischaemic conditioning. Other clinical outcomes such as inotropes use, number of ventilator days, chest pain, ST segment changes, and survival were tabulated.

Results/Outcomes: No report applying RIC to stroke patients was identified; however, a Danish study is due for completion 2012. RIC for elective cardiac procedures was associated with improved clinical outcomes in all but one study. In 5 out of 6 RIC studies the level of troponin release was reduced by 42 to 90%. The study of RIC that reported an increased level of troponin in the RIC group was confounded by higher levels of calcium-channel blocker usage-known to attenuate conditioning mechanisms, and used the highest dose of RIC. The CK levels were reduced by 18 to 40% in PIICC.

Implications: RIC was associated with myocardial protection for elective cardiac procedures inferred from attenuated troponin levels. PIICC was also associated with protection of the heart following ACS as indicated by lower CK levels. There maybe an inverted-U shaped response to the RIC dosage-important consideration for future trials. Current blind spots include the impact of RIC on females, older people and patients with renal, hepatic and pulmonary disease, and ACS or stroke. Currently the use of RIC in the period between symptom onset and reperfusion in ACS or S has not been reported. The window of opportunity between symptom onset and reperfusion is a potential nurse-sensitive period when RIC could be implemented in collaboration with the multidisciplinary team for therapeutic benefit. The development of a cooperative and inclusive international research team utilizing a sustainable free-technology paradigm to develop pilot-studies then assess the promising role of RIC in emergent treatment of ASC and S within the emergency department is advocated
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePost-remote Ischaemic Conditioning for Emergency Management of Acute-Coronary-Syndrome and Stroke?en_GB
dc.identifier.urihttp://hdl.handle.net/10755/162363-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Post-remote Ischaemic Conditioning for Emergency Management of <br/>Acute-Coronary-Syndrome and Stroke?</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Black, Simon, RN, PhD, Grad Dip Advanced Nursing (Emergency), BB</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Division of Nursing and Midwifery, La Trobe University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Lecturer</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Division of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, Bundoora, Victoria, 3073, Australia</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">03 9479 5609</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">s.black@latrobe.edu.au; simonjblack59@gmail.com</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Research Presentation] <br/><br/>Purpose: Post-ischaemic remote conditioning (pRIC) reduced infarction volume. Limited data is available for recommending pRIC into guidelines for acute coronary syndrome (ACS) or stroke (S). Study aim was to review remote ischaemic conditioning (RIC) data for informing a position statement on use of RIC in ACS and S. <br/><br/>Design: Systematic-review utilizing PubMed and ClinicalTrials.gov. Inclusion criteria included clearly described randomization and patient flow, and post-treatment troponin or creatine kinase (CK) levels suitable for calculating percentage difference of enzyme leakage. <br/><br/>Setting: Review conducted in an Australian university school of nursing.<br/><br/>Participants/Subjects: Six studies meet selection criteria involving heterogeneous patients who received RIC for elective procedures: one study reported on 37 children (1.6 +/- 2.2 years) with congenital cardiac disease, and five adult patients without renal, hepatic or pulmonary disease studies (66.25 +/- 8.75 years), who under went abdominal aortic aneurysm repair (one study, n=82), coronary artery bypass surgery (two studies, n=103), or percutaneous coronary intervention (two studies, n=283). Six studies (n=244) were identified that evaluated the impact of post-ischaemic intra-coronary conditioning (PIICC) on ACS. More than 50% of participants were male. All reviewed studies had been approved by local ethics committees. <br/><br/>Methods: Details of patients, randomization, sample size/power analysis, conditioning protocol and outcome measures were tabulated for comparison. The 24 hour level of serum troponin or CK was used to compare the treatment effect of ischaemic conditioning. Other clinical outcomes such as inotropes use, number of ventilator days, chest pain, ST segment changes, and survival were tabulated. <br/><br/>Results/Outcomes: No report applying RIC to stroke patients was identified; however, a Danish study is due for completion 2012. RIC for elective cardiac procedures was associated with improved clinical outcomes in all but one study. In 5 out of 6 RIC studies the level of troponin release was reduced by 42 to 90%. The study of RIC that reported an increased level of troponin in the RIC group was confounded by higher levels of calcium-channel blocker usage-known to attenuate conditioning mechanisms, and used the highest dose of RIC. The CK levels were reduced by 18 to 40% in PIICC. <br/><br/>Implications: RIC was associated with myocardial protection for elective cardiac procedures inferred from attenuated troponin levels. PIICC was also associated with protection of the heart following ACS as indicated by lower CK levels. There maybe an inverted-U shaped response to the RIC dosage-important consideration for future trials. Current blind spots include the impact of RIC on females, older people and patients with renal, hepatic and pulmonary disease, and ACS or stroke. Currently the use of RIC in the period between symptom onset and reperfusion in ACS or S has not been reported. The window of opportunity between symptom onset and reperfusion is a potential nurse-sensitive period when RIC could be implemented in collaboration with the multidisciplinary team for therapeutic benefit. The development of a cooperative and inclusive international research team utilizing a sustainable free-technology paradigm to develop pilot-studies then assess the promising role of RIC in emergent treatment of ASC and S within the emergency department is advocated<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:26:54Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:26:54Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.