Applying RIC/Sham RIC

Q. Can the leg be used instead of the arm?

A. No, this is much more uncomfortable for the patient and difficult to produce enough ischaemia with the amount of muscle mass. There is also much more supporting data for using the arm.

Q. Will the RIC/Sham RIC device affect the ECG recording?

A. There is no evidence to suggest that it does.

Q. What happens if the cuff needs to be moved from one arm to the other?

A. This is fine but should be done during the deflation cycle.

Q. Where should the cuff be placed?

A. As most PPCI radial procedures are performed on the right arm, it is recommended that the cuff be placed on the upper left arm and the right radial access to be used for angiography. If it is common practice for the paramedics to insert the cannula in the left arm then this should be resited to the right arm.

Q. How are the cuffs packaged and how many cuffs will each site receive?

A. The cuffs are individually wrapped. The cuffs are single use only, so should only be used once and disposed of as they will not work a second time.

The cuffs come in three sizes (small, medium and large) and each site will receive 5 small, 5 large and 10 medium at the site initiation. Sites should email ericppci@LSHTM.ac.uk to request a resupply as necessary.

Q. Many patients do not have a manual BP recorded and the BP is taken from the arterial line. Is this an issue?

A. Patients need to have a BP recorded prior to starting RIC/Sham therapy. We recommend using the ambulance measurements. We only recommend repeating the BP measurement if the latest ambulance measurement showed a systolic BP >175mmHg. We do not recommend using BP measurements from the arterial line as this would cause unnecessary delays in initiating RIC/Sham therapy.