Limb Ischemic Preconditioning for Open Heart Surgery in Infants

Abstract

We read the inspiring article by Zhou and colleagues in the January 2010 issue of Pediatric Cardiology [1]. We consider this study to be a fundamental basis for future research because it shows that remote limb ischemic preconditioning is a simple, noninvasive technique that also can be used for infants. But we are concerned about the safety of the cuff pressures used during remote ischemic preconditioning. In the current study, the authors inflated the pressure cuff to 240 mmHg for infants. In previous similar adult study protocols, cuffs have been inflated to 200 or 40 mmHg above the patients’ actual upper arm blood pressure [2, 3]. Tourniquet pressures may cause complications such as soft tissue blisters, burns, rashes, abrasions, nerve-related injuries, and muscle injuries [4]. Lieberman et al. [5] recommended that a cuff pressure of 50 mmHg above systolic blood pressure is sufficient to provide limb ischemia in pediatric patients. We believe future studies should use lower cuff pressures to minimize pressurerelated tissue damage in infants.