Pro: Early Extubation After Pediatric Cardiac Surgery

Abstract

IT HAS BEEN a decade since Alghamdi et al. released their meta-analysis on the topic of early extubation of patients after pediatric cardiac surgery. 1 Alghamdi A.A. Singh S.K. Hamilton B.C. et al. Early extubation after pediatric cardiac surgery: Systematic review, meta-analysis, and evidence-based recommendations. J Card Surg. 2010; 25: 586-595 Crossref PubMed Scopus (80) Google Scholar At that time, there was a lack of good quality comparative clinical trials, and the only reasonable conclusions were the association of early extubation with decreased intensive care unit (ICU) and hospital lengths of stay (LOS) and the absence of a difference in mortality or morbidity between strategies. In 2011, DiNardo and Mittnacht debated the topic of early extubation in the Journal of Cardiothoracic and Vascular Anesthesia, and in the absence of robust evidence to support either opinion, the striking difference between the 2 views was clearly driven by institutional practices and experience. 2 Mittnacht A.J. Pro: Early extubation following surgery for congenital heart disease. J Cardiothorac Vasc Anesth. 2011; 25: 874-876 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar ,3 DiNardo J.A.Con: Extubation in the operating room following pediatric cardiac surgery. 2011;25:877-9. Google Scholar Since then, several studies have been published that have demonstrated the benefits associated with early extubation. In recent years, several institutions have designed multidisciplinary enhanced recovery after cardiac surgery (ERAS) protocols to reduce hospital LOS and complications. 4 Engelman D.T. Ben Ali W. Williams J.B. et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society Recommendations. JAMA Surg. 2019; 154: 755-766 Crossref PubMed Scopus (225) Google Scholar As an example, a team from Boston Children's Hospital recently published its initial experience with an enhanced recovery program for congenital cardiac surgery that clearly highlighted the need for the implementation of a multidisciplinary and multimodal strategy that includes early extubation. 5 Roy N., Parra M.F., Brown M.L., et al. Initial experience introducing an enhanced recovery program in congenital cardiac surgery [E-pub ahead of print]. J Thorac Cardiovasc Surg. doi: 10.1016/j.jtcvs.2019.10.049. Accessed June 15, 2020 Google Scholar