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  • Blauenfeldt, Rolf AnkerlundAarhus University Hospital,Aarhus University (författare)

Remote Ischemic Conditioning for Acute Stroke : The RESIST Randomized Clinical Trial

  • Artikel/kapitelEngelska2023

Förlag, utgivningsår, omfång ...

  • 2023
  • 11 s.

Nummerbeteckningar

  • LIBRIS-ID:oai:lup.lub.lu.se:8b28b426-3cc8-493c-86f5-b604b11b7161
  • https://lup.lub.lu.se/record/8b28b426-3cc8-493c-86f5-b604b11b7161URI
  • https://doi.org/10.1001/jama.2023.16893DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:art swepub-publicationtype
  • Ämneskategori:ref swepub-contenttype

Anmärkningar

  • Importance: Despite some promising preclinical and clinical data, it remains uncertain whether remote ischemic conditioning (RIC) with transient cycles of limb ischemia and reperfusion is an effective treatment for acute stroke. Objective: To evaluate the effect of RIC when initiated in the prehospital setting and continued in the hospital on functional outcome in patients with acute stroke. Design, Setting, and Participants: This was a randomized clinical trial conducted at 4 stroke centers in Denmark that included 1500 patients with prehospital stroke symptoms for less than 4 hours (enrolled March 16, 2018, to November 11, 2022; final follow-up, February 3, 2023). Intervention: The intervention was delivered using an inflatable cuff on 1 upper extremity (RIC cuff pressure, ≤200 mm Hg [n = 749] and sham cuff pressure, 20 mm Hg [n = 751]). Each treatment application consisted of 5 cycles of 5 minutes of cuff inflation followed by 5 minutes of cuff deflation. Treatment was started in the ambulance and repeated at least once in the hospital and then twice daily for 7 days among a subset of participants. Main Outcomes and Measures: The primary end point was improvement in functional outcome measured as a shift across the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) at 90 days in the target population with a final diagnosis of ischemic or hemorrhagic stroke. Results: Among 1500 patients who were randomized (median age, 71 years; 591 women [41%]), 1433 (96%) completed the trial. Of these, 149 patients (10%) were diagnosed with transient ischemic attack and 382 (27%) with a stroke mimic. In the remaining 902 patients with a target diagnosis of stroke (737 [82%] with ischemic stroke and 165 [18%] with intracerebral hemorrhage), 436 underwent RIC and 466 sham treatment. The median mRS score at 90 days was 2 (IQR, 1-3) in the RIC group and 1 (IQR, 1-3) in the sham group. RIC treatment was not significantly associated with improved functional outcome at 90 days (odds ratio [OR], 0.95; 95% CI, 0.75 to 1.20, P =.67; absolute difference in median mRS score, -1; -1.7 to -0.25). In all randomized patients, there were no significant differences in the number of serious adverse events: 169 patients (23.7%) in the RIC group with 1 or more serious adverse events vs 175 patients (24.3%) in the sham group (OR, 0.97; 95% CI, 0.85 to 1.11; P =.68). Upper extremity pain during treatment and/or skin petechia occurred in 54 (7.2%) in the RIC group and 11 (1.5%) in the sham group. Conclusions and Relevance: RIC initiated in the prehospital setting and continued in the hospital did not significantly improve functional outcome at 90 days in patients with acute stroke. Trial Registration: ClinicalTrials.gov Identifier: NCT03481777.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Hjort, NielsAarhus University,Aarhus University Hospital (författare)
  • Valentin, Jan BrinkAalborg University (författare)
  • Homburg, Anne MetteOdense University Hospital (författare)
  • Modrau, BorisAalborg University Hospital (författare)
  • Sandal, Birgitte ForsomHospital Gødstrup (författare)
  • Gude, Martin FaurholdtPrehospital Emergency Medical Services,Aarhus University (författare)
  • Hougaard, Kristina DupontAarhus University Hospital (författare)
  • Damgaard, DorteAarhus University Hospital (författare)
  • Poulsen, MarikaAarhus University Hospital (författare)
  • Diedrichsen, ToveAarhus University Hospital (författare)
  • Schmitz, Marie LouiseAarhus University Hospital (författare)
  • Von Weitzel-Mudersbach, PaulHospital Gødstrup,Aarhus University Hospital (författare)
  • Christensen, Alex AlbanOdense University Hospital (författare)
  • Figlewski, KrystianAalborg University Hospital (författare)
  • Grove, Erik LerkevangAarhus University Hospital,Aarhus University (författare)
  • Hreiðarsdóttir, Margrét KatrínHospital Gødstrup (författare)
  • Lassesen, Henning MorthorstOdense University Hospital (författare)
  • Wittrock, DanielOdense University Hospital (författare)
  • Mikkelsen, SørenOdense University Hospital (författare)
  • Væggemose, UllaPrehospital Emergency Medical Services,Aarhus University (författare)
  • Juelsgaard, PallePrehospital Emergency Medical Services (författare)
  • Kirkegaard, HansAarhus University Hospital,Prehospital Emergency Medical Services (författare)
  • Rostgaard-Knudsen, MartinNorth Denmark Region (författare)
  • Degn, NielsAalborg University Hospital (författare)
  • Vestergaard, Sigrid BreinholtAarhus University Hospital,Aarhus University (författare)
  • Damsbo, Andreas GammelgaardAarhus University,Aarhus University Hospital (författare)
  • Iversen, Ane BullAarhus University Hospital (författare)
  • Mortensen, Janne KærgårdAarhus University,Aarhus University Hospital (författare)
  • Petersson, JesperLund University,Lunds universitet,Neurologi, Lund,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Stroke policy och kvalitetsregisterforskning,Forskargrupper vid Lunds universitet,Neurology, Lund,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Stroke policy and quality register research,Lund University Research Groups,Region Skåne(Swepub:lu)neur-jpe (författare)
  • Christensen, ThomasUniversity of Copenhagen,Copenhagen University Hospital (författare)
  • Behrndtz, Anne BrinkAarhus University,Aarhus University Hospital (författare)
  • Bøtker, Hans ErikAarhus University Hospital (författare)
  • Gaist, DavidOdense University Hospital (författare)
  • Fisher, MarcHarvard Medical School (författare)
  • Hess, David CharlesMedical College of Georgia (författare)
  • Johnsen, Søren PaaskeAalborg University (författare)
  • Simonsen, Claus ZieglerAarhus University,Aarhus University Hospital (författare)
  • Andersen, GretheAarhus University Hospital,Aarhus University (författare)
  • Aarhus University HospitalAarhus University (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:JAMA330:13, s. 1236-12460098-7484

Internetlänk

Hitta via bibliotek

  • JAMA (Sök värdpublikationen i LIBRIS)

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