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RIPC fails to alter outcomes

Two recent large RCTs (RIPCHeart: N Engl J Med 2015; 373:1397-1407 and ERRICA: N Engl J Med 2015; 373:1408-1417) in the 10/8/2015 NEJM examined RIPC via upper arm BP cuff inflation within cardiac surgery patients. Both failed to show benefit even in the surrogate outcomes like AKI, delirium and troponin leak contradicting earlier smaller studies. The editorial concludes with an important issue- how do we dose this therapy?!?

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