Con: Extubating in the Operating Room After Cardiac Surgery Is Not Necessary

Abstract

CARDIAC SURGERY PATIENTS are among the highest risk patients for postoperative pulmonary complications, acute kidney injury, and increased length of hospital stay. 1 Pahwa S Bernabei A Schaff H et al. Impact of postoperative complications after cardiac surgery on long-term survival. J Card Surg. 2021; 36: 2045-2052 Crossref PubMed Scopus (3) Google Scholar In an attempt to decrease these risks, enhanced recovery or fast-track pathways after cardiac surgery have gained traction in recent years. Early extubation is one area of such a pathway that has been shown to decrease the length of stay and reduce healthcare costs in this population. 2 Higgins TL. Pro: Early endotracheal extubation is preferable to late extubation in patients following coronary artery surgery. J Cardiothorac Vasc Anesth. 1992; 6: 488-493 Abstract Full Text PDF PubMed Scopus (113) Google Scholar While most will agree that extubation within 6 hours is ideal after uncomplicated cardiac surgery, there has been an increasing push to take it one step further and provide routine on-table extubation (OTE) after cardiac surgery. To date, there are no randomized controlled trials to support that OTE provides any further benefit over standard fast-track extubation and, thus, should not be routinely performed.