Non-interventional Feasibility Assessment for Fast-Track Cardiac Anesthesia

Area of Science:

• Cardiology
• Anesthesiology
• Intensive Care Medicine

Background:

• Fast-track extubation (FTCA) shortens intensive care unit (ICU) stays after cardiac surgery.
• Early extubation is critical for patient circulation and hospital flow, especially during pandemics.
• Identifying barriers to FTCA is vital for optimizing patient care and resource management.

Purpose of the Study:

• To determine obstacles to early extubation in cardiac surgery patients.
• To analyze perioperative characteristics affecting fast-track extubation success.
• To identify risk factors for delayed extubation.

Main Methods:

• Observational, cross-sectional study with prospective data collection.
• Included 226 cardiac surgery patients, divided into early (≤8 hours) and late (>8 hours) extubation groups.
• Analyzed preoperative, intraoperative, and postoperative data, including complications and length of stay.

Main Results:

• 61.1% of patients were extubated within 8 hours; 38.9% were extubated later.
• Cardiovascular complications (55.7%) were the most common reason for late extubation, followed by respiratory issues (15.9%) and surgeon refusal (15.9%).
• Higher American Society of Anesthesiologists score and red blood cell transfusion were risk factors for longer extubation time.

Conclusions:

• Cardiac and respiratory complications are primary barriers to FTCA in cardiac surgery.
• Surgeon refusal to extubate despite meeting criteria is an improvable obstacle.
• Optimizing preoperative comorbidities, reducing red blood cell transfusions, and updating team protocols are recommended to enhance FTCA.