Risk Factors for Extubation Failure After Pediatric Cardiac Surgery and Impact on Outcomes: A Multicenter Analysis

Area of Science:

• Pediatric Cardiac Surgery
• Critical Care Medicine
• Extubation Management

Background:

• Extubation failure (EF) following pediatric cardiac surgery is a significant complication linked to increased morbidity and mortality.
• Understanding the distinct risk factors for early and late EF is crucial for improving patient outcomes.

Purpose of the Study:

• To identify risk factors for early (within 48 hours) and late (48-168 hours) extubation failure after pediatric cardiac surgery.
• To explore the clinical implications, including mortality and length of stay, associated with early and late EF.

Main Methods:

• Retrospective cohort study utilizing prospectively collected data from the Pediatric Cardiac Critical Care Consortium (PC4) Registry.
• Analysis included pediatric patients undergoing benchmark cardiac operations or heart transplants between 2013 and 2018.
• Demographics and risk factors for EF were analyzed, with a focus on potentially modifiable factors and clinical outcomes like mortality and length of stay (LOS).

Main Results:

• The study analyzed 18,278 extubations, with early EF rates at 5.2% and late EF at 2.5%.
• Cardiopulmonary bypass time, ventilator duration, airway anomalies, genetic abnormalities, pleural effusion, and diaphragm paralysis were associated with both early and late EF.
• Extubation during the day (away from shift change) and nasotracheal intubation decreased early EF risk, while operating room extubation increased early EF risk but decreased late EF risk.

Conclusions:

• Both early and late extubation failure significantly increase length of stay and mortality in pediatric cardiac surgery patients.
• The findings offer benchmarking data stratified by surgical type.
• Modifiable factors such as intubation route, extubation timing, and management of conditions like diaphragm paralysis or pleural effusion present opportunities for reducing EF.