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Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51(10): 596-603
DOI: 10.1055/s-0042-116628
Fachwissen
Anästhesiologie / Intensivmedizin
© Georg Thieme Verlag Stuttgart · New York

Remote Ischaemic Conditioning - Eine Übersicht

Remote Ischaemic Conditioning – an overview
Christian Stoppe
1   Klinik für Operative Intensivmedizin, Uniklinik RWTH Aachen
,
Patrick Meybohm
2   Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt
,
Andreas Goetzenich
3   Klinik für Thorax-, Herz- und Gefäßchirurgie, Uniklinik RWTH Aachen
› Author Affiliations
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Publication History

Publication Date:
20 October 2016 (online)

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Zusammenfassung

Die Strategie des Remote Ischaemic Conditionings (RIC) ist einfach, günstig, nebenwirkungsarm und gehört zu den potentesten kardioprotektiven Strategien der letzten Jahre. Die praktische Durchführung erfolgt mit Hilfe einer Blutdruckmanschette, beispielweise durch 4 wiederholte Zyklen, bei denen pro Zyklus für jeweils 5 min eine Blutdruckmanschette am Oberarm des Patienten auf >200 mmHg aufgepumpt und anschließend entlüftet wird. Erste experimentelle und klinische Pilotdaten zeigten wiederholt eine signifikante Reduktion der Myokardschädigung nach Ischämie/Reperfusion. Dennoch bleibt vor dem Hintergrund der neutralen Ergebnisse von zwei großen klinischen Studien aktuell unklar, ob RIC einen klinisch relevanten Nutzen bei herzchirurgischen Patienten hervorruft. Es scheint wahrscheinlich, dass die Konstellation aus Begleit- und Narkosemedikation für das Versagen des RIC im klinischen Einsatz eine relevante Rolle spielt.

Abstract

The strategy of Remote Ischaemic Conditionings (RIC) is easy to apply, cost effective, low in side effects and belongs to the most potent cardioprotective strategies evaluated within recent years. Its practical application is carried out by simple use of a blood pressure cuff, more precise by 4 repetitive cycles of inflating the cuff above 200 mmHg for 5 minutes followed by an equal long break between the cycles. First experimental and clinical data repetitively demonstrated a significant reduction in myocardial injury following ischemia/reperfusion. Nevertheless, given the neutral results of two recent clinical multicentre trials, the clinical significance and benefits of RIC in cardiac surgery patients remains uncertain. The combination of co-medication and narcotic agents is thought to be responsible for the failed transfer into the clinical practice.

Kernaussagen

  • Die Fernkonditionierung (Remote Ischaemic Conditioning; RIC) gehört im Tierexperiment zu den bislang potentesten kardioprotektiven Strategien.

  • Experimentell konnte durch RIC eine deutliche Reduktion der Infarktgröße erzielt werden.

  • Der Effekt wird durch das wiederholte 5- bis 10-minütige Aufblasen einer Blutdruckmanschette an einer beliebigen Extremität ausgelöst.

  • RIC zeigt einen schützenden Effekt durch Reduktion der Inzidenz an postoperativen Nierenversagen nach herzchirurgischen Eingriffen.

  • Die Translation der beobachteten Effekte in die Klinik erweist sich jedoch weiter als schwierig, wobei die genauen Ursachen dafür unklar sind. Möglicherweise blockieren Begleitmedikamente (Betablocker) und Narkosemittel (Propofol) den Effekt.

  • Aktuell gehört es zu den zentralen anästhesiologisch-wissenschaftliche Herausforderungen, die potenziellen Störfaktoren zu identifizieren, damit diese protektive Strategie klinisch angewendet werden kann und so die Voraussetzungen für mehr Organprotektion schafft.

  • RIC hat bei Patienten mit akutem Myokardinfarkt im Vergleich zum herzchirurgischen Patienten möglicherweise einen klinischen Nutzen – aktuell wird die CONDI-2-Studie durchgeführt, um den klinischen Nutzen von RIC bei Patienten mit STEMI (ST-Hebungs-Myokardinfarkt) zu klären.

Schlüsselwörter:

Fernkonditionierung - Herzoperation - Kardioprotektion - Ischämie und Reperfusion - Organschädigung

Keywords:

cardiac surgery - cardioprotection - remote ischaemic conditioning - inflammation - ischaemia-reperfusion - organ injury
 

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