1. Previous Relative Trials
The Effect of Remote Ischaemic Preconditioning and Glyceryl TriNitrate on peri-operative myocardial injury in Cardiac Bypass Surgery Patients (The ERIC-GTN) Trial. Hamarneh A1; Shanahan H2; McGowan J1; Bulluck H1; Ramlall M1; Chung R1; Cordery R2; Kolvekar S2; Yellon D1; Hausenloy D1,3,4 1The Hatter Cardiovascular Institute, UCL 2 Bart’s Heart Centre, St. Bart’s Health NHS Trust. 3 National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore 4 Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore 
METHOD
Double blinded, randomized, four arm study:
RIC (three 5-minute cycles of simultaneous upper-arm and thigh cuff inflation/deflation) + GTN infusion.
RIC + normal saline infusion.
Sham (two cuffs left uninflated for 30 minutes) + GTN infusion.
Sham + normal saline infusion.
Over 18Yr old patients undergoing elective CABG and/or Valve surgery
ABSTRACT
TITLE: ERIC-GTN trial
BACKGROUND:
Myocardial Ischemia-reperfusion Injury was first described in 1960.
Opening an occluded vessel resulted in further myocardial injury as a result of restoration of blood flow to the myocardium.
Remote ischemic conditioning (RIC) using transient limb ischaemia/reperfusion has been reported to reduce perioperative myocardial injury in patients undergoing coronary artery bypass grafting and/or valve surgery. Whether intravenous glyceryl trinitrate (GTN) therapy administered during cardiac surgery confers cardioprotection and whether it interferes with RIC cardioprotection is not clear and is investigated in the ERIC-GTN trial
Previous Relative Trials
Remote Ischaemic Preconditioning in human Coronary Artery Bypass Surgery (Rahman et.al, 2010 (1)
Primary Endpoint
peri-operative myocardial injury (PMI) as quantified by the 72 hours high sensitive troponin area-under-the-curve.
Secondary End Point
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Maximum inotrope score in the 72-hour perioperative period.
Ventilatory requirements.
Atrial fibrillation.
Acute kidney injury within 72 hours of surgery.
Length of intensive care unit and hospital stay.
Excepteur Sint
Lkl
(n=212)
Controls
(n=27)
Lorum Wt (kg)
18 (SD 10) 29
(SD 07)
Ipsum (wk)
31 (SD 5)
37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%)
121 (571%)
2 (09%)
1 (05%)
9 (42%)
7 (259%)
18 (667%)
1 (37%)
Proident F
Lorem
106 (50%)
101 (476%)
5 (24%)
17 (63%)
10 (37%)
Nostrud: N Y
172 (811%)
22 (104%)
18 (85%)
26 (963%)
CONCLUSIONS
The ERIC-GTN trial will investigate whether intravenous GTN therapy administered during cardiac surgery reduces PMI and whether it interferes with RIC cardioprotection.
Effect of remote ischaemic preconditioning on clinical outcomes in patients undergoing cardiac bypass surgery. Candilio et.al,2012 (2)
Hirofumi Tanaka, Ph.D. - Ischemic Pre-Conditioning and Athletic Performance.
References
Rahman IA, Mascaro JG, Steeds RP, Frenneaux MP, Nightingale P, Gosling P, et al. Remote ischemic preconditioning in human coronary artery bypass surgery: from promise to disappointment? Circulation. 2010;122(11 Suppl):
Candilio L, Malik A, Ariti C, Barnard M, Di Salvo C, Lawrenceconditioning on clinical outcomes in patients undergoing cardiac bypass surgery: a randomised controlled clinical trial. Heart (British Cardiac Society). 2015;101(3):185-92
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