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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Predictors of extubation in the operating room after pediatric cardiac surgery: A single-center retrospective study
Mehmet Biçer1, Şima Kozan2, Kamil Darçın3
1Department of Pediatric Cardiovascular Surgery, Koç University Hospital, Istanbul, Türkiye.
Insights
On-table extubation is feasible for pediatric congenital heart disease patients, reducing intensive care unit and hospital stays. Factors like lactate levels and bypass time influence success, with lower values indicating better outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Congenital heart disease (CHD) necessitates complex surgical interventions.
- On-table extubation is a strategy to potentially shorten recovery times post-cardiac surgery.
- Evaluating the feasibility and outcomes of on-table extubation in CHD patients is crucial.
Purpose of the Study:
- To assess the outcomes of an on-table extubation strategy in pediatric patients undergoing surgery for congenital heart disease.
- To identify factors associated with successful on-table extubation in this population.
Main Methods:
- Retrospective analysis of 114 pediatric patients with CHD between April 2021 and November 2022.
- Evaluation using the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STS-EACTS) scoring system.
- Correlation of perioperative data with extubation status.
Main Results:
- 56% of patients were successfully extubated in the operating room.
- Factors associated with on-table extubation included lower fluid balance, shorter cardiopulmonary bypass and cross-clamp times.
- Pre-extubation lactate, STS-EACTS mortality category, estimated mortality, and morbidity were significant predictors.
- Multivariate analysis identified pre-extubation lactate and estimated postoperative hospital stay as key factors.
Conclusions:
- The on-table extubation strategy is feasible in pediatric CHD patients.
- Higher lactate levels, increased fluid balance, longer bypass/cross-clamp times, and surgical complexity predict extubation failure.
- Successful on-table extubation is linked to shorter intensive care unit and hospital stays.
Background:
In this study, we aimed to evaluate the outcomes of our on-table extubation strategy in patients with congenital heart disease.
Methods:
Between April 2021 and November 2022, a total of 114 pediatric patients (58 males, 56 females; median age: 25.3 months; range, 57.5 to 4.4 months) who were operated for congenital heart diseases were retrospectively analyzed. The patients were evaluated according to the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STS-EACTS) scoring system. Perioperative patient data were analyzed and correlated with the extubation status.
Results:
Overall, 56% of the patients were extubated in the operating room. There was an association between fluid balance per unit body surface area, longer cardiopulmonary bypass and cross-clamp times and on-table extubation. Lactate value prior to extubation, STS-EACTS mortality category, estimated mortality, and estimated morbidity were statistically significant with regards to the achievability of extubation. Multivariate analysis revealed lactate value prior to extubation and estimated postoperative length of hospital stay to be significant factors affecting on-table extubation. There was a significant correlation between decreased length of intensive care unit and hospital stay and on-table extubation.
Conclusion:
The outcomes of our on-table extubation strategy for patients with congenital heart disease reveal the feasibility of this approach. Higher lactate and fluid balance/body surface area levels, longer cross-clamp and cardiopulmonary bypass durations, increased surgical complexity are indicators of a failure to perform on-table extubation. This strategy is also associated with shorter intensive care unit and hospital length of stays as an additional clinical benefit.
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