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Published on: August 2, 2024
On-table Extubation after Open Heart Surgery in Children: An Experience from a Tertiary Care Hospital in a Developing
Mehar Hoda1, Anwarul Haque1, Fareena Aijaz1
1Department of Pediatrics, Aga Khan University Hospital, Sindh, Pakistan.
Insights
On-table extubation (OTE) is safe for children after open heart surgery. This study found OTE in selected pediatric patients resulted in minimal postoperative complications and no mortality.
Area of Science:
- Pediatric Cardiac Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Advances in pediatric cardiac surgery have led to evolving extubation strategies.
- On-table extubation (OTE) is an emerging technique for children undergoing open heart surgery.
Purpose of the Study:
- To evaluate the incidence of postoperative complications in pediatric patients extubated on table after open heart surgery.
- To assess the safety and feasibility of OTE in this population.
Main Methods:
- Retrospective, descriptive study design.
- Inclusion of pediatric patients (0-18 years) who underwent open heart surgery between January 2011 and June 2013.
- Assessment of immediate postoperative complications including re-intubation, bleeding, low cardiac output syndrome, and arrhythmia.
Main Results:
- 82 pediatric patients were included in the study.
- 97.8% of patients experienced no complications in the pediatric intensive care unit (PICU).
- Only one patient required re-intubation, and one experienced medically managed arrhythmia; no mortality was observed.
Conclusions:
- On-table extubation is a feasible and safe approach for selected pediatric patients following open heart surgery.
- The study demonstrated a low rate of major complications in the PICU post-OTE.
Background:
Recent advances in various disciplines of medicine have significantly changed the courses following cardiac surgery in children. On-table extubation (OTE) after open heart surgery in children is evolving.
Objective:
To assess the rate of postoperative complications in children extubated on table after open heart surgery.
Design:
This is a retrospective, descriptive study.
Setting:
Operating room (OR) then admitted to the pediatric intensive care unit (PICU).
Patients:
All pediatric patients (between 0 and 18 years) undergoing open heart surgery between January 2011 and June 2013.
Intervention:
On-table extubation.
Outcome Measures:
Rates of immediate postoperative complications, i.e., re-intubation, significant bleeding, low cardiac output syndrome, and arrhythmia in PICU, were assessed. Data are presented as frequencies and mean ± standard deviation.
Results:
A total of 82 patients were included. Mean age at time of operation was 7.25 ± 6.6 years. Fifty-three percent (n = 44) were <5 years old and 64% (n = 53) were men. Ventricular septal defect (47%, n = 39) was the most common lesion, followed by atrial septal defect (36%, n = 30), and tetralogy of Fallot (15%, n = 12), which were repaired. Cardiopulmonary bypass and aortic cross clamp time were 72.3 ± 34.2 and 47.3 ± 27.8 minutes, respectively. The mean inotrope score was 2.66 ± 3.53. There was no mortality in the cohort, whereas 97.8% (n = 80) had no complications during PICU stay. One patient (1.1%) required re-intubation for respiratory failure and one patient (1.1%) had arrhythmia that was medically managed. The mean length of PICU stay was 1.77 ± 0.985 days.
Conclusion:
On-table extubation in children after open heart surgery was feasible and safe in selected group of patients. There was no major complication observed in the PICU.
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