The Experience of Early Extubation After Paediatric Congenital Heart Surgery in a Chinese Hospital

Abstract

Early extubation has become widely adopted in cardiac surgery practices. This study aimed to present experience of early extubation after congenital heart surgery and to explore the factors that affect successful immediate postoperative extubation and early extubation. A retrospective analysis was performed of all patients who underwent congenital heart surgery with cardiopulmonary bypass (CPB) at Shenzhen Children's Hospital between 01 May 2015 and 30 September 2019. The demographic and cardiac surgery information were derived from the medical records. Multivariable logistic regression models were used to explore the influence factors for successful immediate postoperative extubation and early extubation. This study consisted of 2,060 patients, 65.0% of whom were extubated in the operating room and 16.1% of whom were extubated early (within 6 hours) in the Intensive Care Unit. The overall rates of reintubation and nasal continuous positive airway pressure were 2.0% and 6.4%, respectively. Preoperative weight (OR, 1.24; 95% CI, 1.20-1.29), preoperative pneumonia (OR, 0.60; 95% CI, 0.44-0.80), CPB type (OR, 1.23; 95% CI, 1.06-1.43), CPB time (OR, 0.98; 95% CI, 0.98-0.99), deep hypothermic circulatory arrest (OR, 0.42; 95% CI, 0.25-0.70), and Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery Congenital Heart Surgery (STAT) categories (OR, 0.54; 95% CI, 0.45-0.65) were included in the immediate postoperative extubation model. In addition to the above six variables, ultrafiltration (OR, 0.63; 95% CI, 0.44-0.89) was also included in the early extubation model. Similar results were found in the immediate postoperative extubation model for non-newborns. The influencing factors for early extubation in the non-newborn population included preoperative weight, preoperative pneumonia, ultrafiltration, CPB time, and STAT categories. Early extubation for children with congenital heart surgery was successful in this hospital. Patients with early extubation had a lower reintubation rate and nasal continuous positive airway pressure rate, and a shorter length of stay in the ICU and hospital. Early extubation was influenced by age, weight at surgery, preoperative pneumonia, CPB type, CPB time, deep hypothermic circulatory arrest, ultrafiltration, and STAT categories.