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Results of an Early Extubation Protocol following Congenital Cardiac Surgery in a Small Volume Program
Raina Sinha, MD, MPH, Vikram Lyall, Jill Sullivan, PA-C, Amy Bouchard, DO, Dennis Mello, MD.
Connecticut Children's, Hartford, CT, USA.

Objectives - To evaluate outcomes of an early extubation (EE) protocol (either in the operating room (OR) or within 24 hours postoperatively in the intensive care unit (ICU)) in a small volume pediatric and adult congenital cardiac program.
Methods - A retrospective single center chart review was performed on all cardiac surgery patients from March 2018 to December 2019. Statistical analysis was performed via SAS and a p-value < 0.05 denoted statistical significance.
Results - A total of 173 patients were identified (median age 13 months, interquartile range 3-103) and their characteristics are listed in Table 1. Of these, 136 patients (78.6%) - Group I, achieved early extubation within 24 hours and 37 (21.4%) - Group II were extubated after 24 hours. The overall rate of re-intubation was 6.4% (n =11) and mortality was 1.7% (n = 3). Patients in the early extubation group underwent surgeries with lower STAT category (86.9% vs. 57.1% were STAT ≤2, p<0.001). They were also noted to have a statistical difference with regards to decrease in anesthesia time, aortic cross clamp time, cardiopulmonary bypass time (CPB), transfusion rates, and hospital length of stay.
Conclusions - Successful extubation is feasible and successful for many patients undergoing cardiac operations in the operating room or within 24 hours. Given the significant resource utilization of prolonged mechanical ventilation and associated impact on the postoperative clinical course, a systematic approach for planned early extubation can be considered for patients with the appropriate physiology.
Table 1. Patient Characteristics

Overall Sample (N=173)Extubated <24 hours (n=136) Group IExtubated >24 hours (n=37) Group IIp-value
Age (months) (median, IQR)13 (3-104)36.0 (5-151)1.0 (0-5)<0.001
Stat category (n,%)<0.001
≤2133 (80.6)113 (86.9)20 (57.1)
>232 (19.4)17 (13.1)15 (42.9)
Pre-op Mechanical Ventilation (n,%)0.158
Yes4 (2.3)2 (1.5)2 (5.4)
No169 (97.7)134 (98.5)35 (94.6)
Anesthesia length (hours) (median, IQR)5.9 (4.4-7.6)5.7 (4.2-7.2)7.7 (5.9-9.2)<0.001
Lowest temperature (median, IQR)34.1 (32.0-35.3)34.7 (33.1-35.4)30.6 (26.3-33.1)<0.001
XC (min) (median, IQR)41 (0-80)32.5 (0-77.5)75 (27-108)0.002
CPB (n,%)0.391
Yes131 (75.7)101 (74.3)30 (81.1)
No42 (24.3)35 (25.7)7 (18.9)
CPB Time (min)(median, IQR)90.5 (31.5-129.5)79 (0-119)138 (91-194)<0.001
Transfusion (n,%)<0.001
Yes99 (57.2)67 (49.3)32 (86.5)
No74 (42.8)69 (50.7)5 (13.5)
Re-intubation (n,%)0.013
Yes11 (6.4)5 (3.7)6 (16.2)
No162 (93.6)131 (96.3)31 (83.8)
Hospital length of stay (median, IQR)5.3 (4.1-13.5)4.4 (3.4-7.4)28.5 (13.5-35.9)<0.001


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