IMMEDIATE EXTUBATION AFTER PROFOUND HYPOTHERMIC CIRCULATORY ARREST

Abstract

Introduction: Management of patients undergoing profound hypothermic circulatory arrest (PHCA) has generally included 8-24 hours of mechanical ventilation after surgery. [1] Immediate extubation (IE), <60 minutes after surgery, has been standard practice at our institution in children undergoing PHCA due to perceived benefits of less cost, reduced respiratory infections, and better cardiac function. [2] This study evaluates the results of our practice. Methods: The charts of 100 consecutive PHCA patients between the ages of 1 and 36 months at Loma Linda University Medical Center between 12-92 and 6-96 were reviewed. Information collected included age, weight, type of surgical procedure, fentanyl dose, minimum core temperature, circulatory arrest time, time of extubation and reintubation. PHCA was managed with a standard protocol with core temperatures <24[degree sign]C. Anesthetic techniques included inhalational and intravenous inductions and maintenance with fentanyl, muscle relaxants, and inhalational agents titrated to blood pressure. IE vs postoperative ventilation (POV) was jointly agreed to by the surgeon and anesthesiologist. Results: The data was analyzed for possible associations between the patient variables and IE and reintubation within the first postoperative day. Statistical analysis was by t-test, ANOVA or Chi square as appropriate. IE was performed in 46% of patients. The distribution of IE in various surgical procedures is shown in Table 1.Table 1: IE by surgery typeIE patients had lower total fentanyl doses, greater ages and weights, and shorter circulatory arrest times compared to the POV group (Table 2)Table 2: IE vs POV, mean +/- SD4/46 of IE patients were reintubated, all for reoperation. Early mortality, defined as death within one month of surgery, occurred in 7 patients. None of these were in the IE group. Discussion: The data suggest that IE may be accomplished after PHCA with mortality and reintubation rates comparable to results with prolonged intubations. Prospective trials are needed to confirm our retrospective data.