Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Remote Ischemic Preconditioning on Mortality and Morbidity in Cardiac Surgery: a Randomized Controlled Trial
Brief Summary: Perioperative myocardial injury is a serious complication of cardiac surgery. This complication increases both mortality and morbidity of cardiac surgery. Remote ischemic preconditioning (RIPC) is the concept that brief ischemia followed by reperfusion in an organ can reduce subsequent ischemia-reperfusion injury in distant organs. Recent several clinical trials showed powerful myocardial protective effect of remote ischemic preconditioning by reducing postoperative cardiac enzymes. However, the evidence that remote ischemic preconditioning can improve the clinical outcomes such as mortality and morbidity, is still lacking. The investigators perform a multicenter randomized controlled study to evaluate that remote ischemic preconditioning can improve the outcomes of cardiac surgery.


Options:
A: Inclusion Criteria:

* highly trained cyclists (VO2 peak \> 50 ml/kg bodyweight)
* refrain from cocoa ingestion during trial
* training continued throughout testing
* \> 20 years
* male

Exclusion Criteria:

* \> 36 years
* poor endothelial function
* acute infection
* any chronic heart or pulmonary disease
* arrhythmias
* acute or chronic renal failure
* smokers
* cardio-vascular risk factors : diabetes mellitus, hypertension, hyperlipidemia
* intake of nutrition supplements (l-arginine, creatinine)
* intake of WADA listed doping substances
B: Inclusion Criteria:

* adult patients undergoing cardiac surgery

Exclusion Criteria:

* emergent operation
* preoperative use of inotropics or mechanical assist device,
* left ventricular ejection fraction less than 30%,
* severe liver, renal and pulmonary disease,
* recent myocardial infarction (within 7 days),
* recent systemic infection or sepsis (within 7 days)
* peripheral vascular disease affecting upper limbs
* amputation of the upper limbs
* major combined operation such as aortic surgery or carotid endarterectomy
* descending thoracic aortic surgery
* rare surgeries; cardiac transplantation, correction of complicated congenital anomalies, pulmonary thromboembolectomy, etc
C: Inclusion Criteria:

1. Patients undergoing CABG with or without valve surgery using blood cardioplegia
2. Patients aged 18 years and above
3. Patients with an additive Euroscore greater than or equal to 5

Exclusion Criteria:

1. Cardiogenic shock
2. Cardiac arrest on current admission
3. Pregnancy
4. Significant peripheral arterial disease affecting the upper limbs
5. Patients with significant hepatic dysfunction (Prothrombin\>2.0 ratio)
6. Patients with significant pulmonary disease (FEV1\<40% predicted)
7. Patients with known renal failure with a GFR\<30 mL/min/1.73 m2
8. Patients on glibenclamide or nicorandil, as these medications may interfere with RIC
9. Patients recruited into another study which may impact on the ERICCA study
D: Inclusion Criteria:

* Age \> 18 years all patients admitted for on- pump CABG and/or valve surgery
* Able to give consent

Exclusion Criteria:

* Allergies to excipients of IMP and placebo
* Chronic Renal failure (eGFR\<30 ml/min/kg)
* Severe liver disease
* Peripheral arterial disease
* Pregnant or lactating women

Answer: B