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Remote Ischemic Con...
Remote Ischemic Conditioning for Acute Stroke : The RESIST Randomized Clinical Trial
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- Blauenfeldt, Rolf Ankerlund (författare)
- Aarhus University,Aarhus University Hospital
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- Hjort, Niels (författare)
- Aarhus University,Aarhus University Hospital
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- Valentin, Jan Brink (författare)
- Aalborg University
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- Homburg, Anne Mette (författare)
- Odense University Hospital
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- Modrau, Boris (författare)
- Aalborg University Hospital
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- Sandal, Birgitte Forsom (författare)
- Hospital Gødstrup
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- Gude, Martin Faurholdt (författare)
- Prehospital Emergency Medical Services,Aarhus University
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- Hougaard, Kristina Dupont (författare)
- Aarhus University Hospital
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- Damgaard, Dorte (författare)
- Aarhus University Hospital
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- Poulsen, Marika (författare)
- Aarhus University Hospital
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- Diedrichsen, Tove (författare)
- Aarhus University Hospital
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- Schmitz, Marie Louise (författare)
- Aarhus University Hospital
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- Von Weitzel-Mudersbach, Paul (författare)
- Hospital Gødstrup,Aarhus University Hospital
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- Christensen, Alex Alban (författare)
- Odense University Hospital
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- Figlewski, Krystian (författare)
- Aalborg University Hospital
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- Grove, Erik Lerkevang (författare)
- Aarhus University,Aarhus University Hospital
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- Hreiðarsdóttir, Margrét Katrín (författare)
- Hospital Gødstrup
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- Lassesen, Henning Morthorst (författare)
- Odense University Hospital
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- Wittrock, Daniel (författare)
- Odense University Hospital
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- Mikkelsen, Søren (författare)
- Odense University Hospital
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- Væggemose, Ulla (författare)
- Aarhus University,Prehospital Emergency Medical Services
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- Juelsgaard, Palle (författare)
- Prehospital Emergency Medical Services
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- Kirkegaard, Hans (författare)
- Aarhus University Hospital,Prehospital Emergency Medical Services
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- Rostgaard-Knudsen, Martin (författare)
- North Denmark Region
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- Degn, Niels (författare)
- Aalborg University Hospital
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- Vestergaard, Sigrid Breinholt (författare)
- Aarhus University Hospital,Aarhus University
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- Damsbo, Andreas Gammelgaard (författare)
- Aarhus University,Aarhus University Hospital
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- Iversen, Ane Bull (författare)
- Aarhus University Hospital
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- Mortensen, Janne Kærgård (författare)
- Aarhus University Hospital,Aarhus University
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- Petersson, Jesper (författare)
- Lund 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
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- Christensen, Thomas (författare)
- University of Copenhagen,Copenhagen University Hospital
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- Behrndtz, Anne Brink (författare)
- Aarhus University,Aarhus University Hospital
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- Bøtker, Hans Erik (författare)
- Aarhus University Hospital
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- Gaist, David (författare)
- Odense University Hospital
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- Fisher, Marc (författare)
- Harvard Medical School
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- Hess, David Charles (författare)
- Medical College of Georgia
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- Johnsen, Søren Paaske (författare)
- Aalborg University
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- Simonsen, Claus Ziegler (författare)
- Aarhus University,Aarhus University Hospital
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- Andersen, Grethe (författare)
- Aarhus University,Aarhus University Hospital
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(creator_code:org_t)
- 2023
- 2023
- Engelska 11 s.
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Ingår i: JAMA. - 0098-7484. ; 330:13, s. 1236-1246
- Relaterad länk:
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http://dx.doi.org/10...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- 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
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
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Blauenfeldt, Rol ...
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Hjort, Niels
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Valentin, Jan Br ...
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Homburg, Anne Me ...
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Modrau, Boris
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Sandal, Birgitte ...
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Gude, Martin Fau ...
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Hougaard, Kristi ...
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Damgaard, Dorte
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Poulsen, Marika
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Diedrichsen, Tov ...
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Schmitz, Marie L ...
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Von Weitzel-Mude ...
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Christensen, Ale ...
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Figlewski, Kryst ...
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Grove, Erik Lerk ...
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Hreiðarsdóttir, ...
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Lassesen, Hennin ...
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Wittrock, Daniel
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Mikkelsen, Søren
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Væggemose, Ulla
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Juelsgaard, Pall ...
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Kirkegaard, Hans
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Rostgaard-Knudse ...
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Degn, Niels
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Vestergaard, Sig ...
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Damsbo, Andreas ...
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Iversen, Ane Bul ...
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Mortensen, Janne ...
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Petersson, Jespe ...
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Christensen, Tho ...
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Behrndtz, Anne B ...
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Bøtker, Hans Eri ...
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Gaist, David
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Fisher, Marc
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Hess, David Char ...
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Johnsen, Søren P ...
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Simonsen, Claus ...
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Andersen, Grethe
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- MEDICIN OCH HÄLSOVETENSKAP
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och Klinisk medicin
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och Neurologi
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