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

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.