Abstract 34: Implementation of a Novel Fast-Track Extubation Protocol after Routine and Complex Adult Cardiovascular Operations

Abstract

Background: The Society of Thoracic Surgeons (STS) defines early extubation after cardiac operations as endotracheal extubation and separation from mechanical ventilation in less than 6 hours of surgery, which is associated with improved postoperative outcomes. Objectives: 1. To improve rates of early extubation in post-operative cardiac surgery patients. 2. To evaluate implementation of a multidisciplinary fast-track extubation (FTE) protocol on the duration of mechanical ventilation after adult cardiac surgery as compared to historical unmatched-controls. Methods: After IRB approval, prospective data were collected on 101 consecutive patients identified by the operating surgeon as appropriate for early extubation based on standard protocols (Control Cohort). Our multidisciplinary stakeholder group evaluated barriers to early extubation and developed a sustainable FTE protocol. Post-implementation data was collected for 3 months (FTE Cohort). A structural framework to alter culture and behavior was utilized for long-term adoption of our protocol. Results: The study included 312 patients (Control Cohort N=101 / FTE Cohort N=211). Patient and procedural demographics were similar between the groups. Extubation occurred within 6 hours in 48% (N=48) in the control cohort versus 73% (N=153) in the FTE cohort (p <0.001) (Figure 1). Following implementation of the FTE protocol, patients with more complex surgeries, not meeting original inclusion criteria, were also safely extubated using the protocol. Conclusion: Our FTE protocol safely improved the rate of early extubation after routine and complex cardiac surgery. A behavioral change framework was instrumental in establishing and maintaining staff engagement.