Related Experiment Video
Updated: Aug 29, 2025
Author Spotlight: Advancing Awake Nasotracheal Intubation with Flexible Video Rhino-Laryngoscopes
Published on: August 2, 2024
Effects of on-Table Extubation after Pediatric Cardiac Surgery
Torsten Baehner1,2, Philipp Pruemm1, Mathieu Vergnat3
1Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany.
Insights
On-table extubation (OTE) in pediatric cardiac surgery is feasible and leads to shorter intensive care unit (ICU) stays and hospital length of stay (LOS). This approach also reduced catecholamine dependency and fluid shifts compared to delayed extubation (DET).
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Enhanced Recovery After Surgery (ERAS) Protocols
Background:
- Enhanced Recovery After Surgery (ERAS) protocols aim to improve outcomes and reduce costs by optimizing patient physiology.
- While ERAS is established in adult cardiac surgery, its application in pediatric cardiac surgery remains limited.
- On-table extubation (OTE) is an emerging strategy within ERAS protocols.
Purpose of the Study:
- To evaluate the impact of on-table extubation (OTE) versus delayed extubation (DET) on postoperative outcomes in pediatric cardiac surgery patients.
- To compare intensive care unit (ICU) treatment duration, length of hospital stay (LOS), and other key clinical indicators between OTE and DET groups.
Main Methods:
- Retrospective analysis of pediatric cardiac surgery cases in children under two years old requiring cardiopulmonary bypass in 2021.
- Exclusion of emergency, off-pump, and preoperatively ventilated cases.
- Propensity score matching was used to control for confounding variables including age, weight, bypass duration, and STATS-Score.
Main Results:
- The OTE group demonstrated significantly reduced ICU treatment duration (75.9 vs. 217.2 hours) and hospital LOS (11.1 vs. 20.1 days) compared to the DET group.
- OTE patients showed fewer catecholamine dependencies at multiple postoperative time points.
- The DET group experienced a significantly increased intra-fluid shift relative to body weight.
Conclusions:
- On-table extubation is a feasible approach in pediatric cardiac surgery.
- OTE is associated with a more favorable postoperative course, including reduced ICU and hospital LOS, and decreased need for vasopressors.
- These findings support the wider adoption of OTE within ERAS protocols for pediatric cardiac surgery.
Abstract:
Background: Enhanced recovery after surgery (ERAS) protocols are utilizing a multidisciplinary approach, reassessing physiology to improve clinical outcomes, reducing length of hospital stay (LOS) stay, resulting in cost reduction. Since its introduction in colorectal surgery. the concept has been utilized in various fields and benefits have been recognized also in adult cardiac surgery. However, ERAS concepts in pediatric cardiac surgery are not yet widely established. Therefore, the aim of the present study was to assess the effects of on-table extubation (OTE) after pediatric cardiac surgery compared to the standard approach of delayed extubation (DET) during intensive care treatment. Study Design and Methods: We performed a retrospective analysis of all pediatric cardiac surgery cases performed in children below the age of two years using cardiopulmonary bypass at our institution in 2021. Exclusion criteria were emergency and off pump surgeries as well as children already ventilated preoperatively. Results: OTE children were older (267.3 days vs. 126.7 days, p < 0.001), had a higher body weight (7.0 ± 1.6 kg vs. 4.9 ± 1.9 kg, p < 0.001), showed significantly reduced duration of ICU treatment (75.9 ± 56.8 h vs. 217.2 ± 211.4 h, p < 0.001) and LOS (11.1 ± 10.2 days vs. 20.1 ± 23.4 days; p = 0.001) compared to DET group. Furthermore, OTE children had significantly fewer catecholamine dependencies at 12-, 24-, 48-, and 72-h post-surgery, while DET children showed a significantly increased intrafluid shift relative to body weight (109.1 ± 82.0 mL/kg body weight vs. 63.0 ± 63.0 mL/kg body weight, p < 0.001). After propensity score matching considering age, weight, bypass duration, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Mortality (STATS)-Score, and the outcome variables, including duration of ICU treatment, catecholamine dependencies, and hospital LOS, findings significantly favored the OTE group. Conclusion: Our results suggest that on-table extubation after pediatric cardiac surgery is feasible and in our cohort was associated with a favorable postoperative course.
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...