This multicenter, randomized, controlled trial involving adults undergoing elective cardiac surgery with cardiopulmonary bypass while under propofol anesthesia compared upper-limb remote ischemic preconditioning with a sham intervention. No relevant benefit was observed. Cardiac surgery is associated with a predictable risk of end-organ ischemic and reperfusion injury. Transient ischemia of nonvital tissue, known as remote ischemic preconditioning (RIPC), is reported to help remote vital organs withstand a subsequent prolonged ischemic event. 1 Although proof-of-concept trials suggested that RIPC provides protection against myocardial and kidney injury, as determined by serum cardiac and renal biomarkers, in patients undergoing cardiovascular surgery, 2 – 4 more recent studies failed to show significant differences between the RIPC and control groups with respect to troponin release, inotropic or vasoconstrictor support, renal dysfunction, and lung injury. 5 – 10 Only a few studies have included . . .