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Routine Use of an On-Table Extubation Protocol in Pediatric Cardiac Surgery-Our Experience With Life in the Fast Lane

Jothinath Kaushik1, Raju Vijayakumar1, Pavithra Ramanath2

  • 1Department of Cardiac Anesthesiology, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, India.

World Journal for Pediatric & Congenital Heart Surgery
|February 13, 2025
PubMed

Insights

Implementing an on-table extubation protocol for pediatric cardiac surgery significantly reduces intensive care unit and hospital stays. This approach also lowers overall hospital costs in developing countries.

Area of Science:

  • Pediatric Cardiac Surgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Evaluating the efficacy of an on-table extubation protocol in pediatric cardiac surgery.
  • Assessing the benefits of implementing this protocol as routine practice in a developing country.
  • Focus on improving patient outcomes and resource utilization in pediatric cardiac surgical care.

Purpose of the Study:

  • To determine the effectiveness of an on-table extubation protocol for children undergoing cardiac surgery.
  • To quantify the reduction in intensive care unit (ICU) stay, hospital stay, and hospital costs.
  • To assess the feasibility and benefits in a resource-limited setting.

Main Methods:

  • Prospective observational study at a tertiary care hospital.
  • Inclusion of 226 pediatric patients (1 month to 18 years) undergoing elective cardiac surgery.
  • Exclusion of high-risk patients (RACHS score ≥ 4, neonates, preoperatively ventilated, emergency cases). On-table extubation candidates: RACHS 1, 2, 3.

Main Results:

  • Successful on-table extubation in 142 out of 226 patients (62.83%).
  • Higher success rates observed in infants (46.6%) and children aged 5-18 years (79.3%).
  • Significantly shorter ICU stay (23 vs. 28/71 hours), hospital stay (102 vs. 122/184 hours), and lower hospital costs (INR 2,09,011 vs. 2,25,430/2,53,541) in the on-table extubation group.

Conclusions:

  • The on-table extubation protocol is effective in pediatric cardiac surgery patients.
  • Significant reductions in ICU stay, hospital stay, and hospital costs were achieved.
  • This protocol offers substantial benefits, particularly in developing countries.

Keywords:
enhanced recovery after cardiac surgeryon-table extubation protocolpediatric enhanced recovery after cardiac surgery

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