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Endotracheal or ET intubation is a critical medical procedure used to secure a patient's airway, often in acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, or during general anesthesia.
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Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
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On-Table Extubation After Pediatric Cardiac Surgery: A Systematic Review.

Vanessa Tapioca1, Lucas Caetano2, Tathiane Gibicoski3

  • 1Department of Medicine, Bahiana School of Medicine and Public Health, Salvador, Brazil.

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|August 13, 2025
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Summary

On-table extubation in pediatric cardiac surgery may reduce reintubation rates and length of stay. However, more high-quality studies are needed to confirm safety and benefits due to potential bias and heterogeneity.

Keywords:
cardiac surgerycongenital heart diseasefast‐track extubationimmediate extubationon‐table extubationpediatric surgery

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Area of Science:

  • Pediatric Cardiac Surgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • On-table extubation is increasingly considered for pediatric cardiac surgery to shorten ventilation time.
  • Concerns persist regarding reintubation risk, patient selection, and outcome variability.

Purpose of the Study:

  • To systematically review the literature on the effectiveness and safety of on-table versus off-table extubation in pediatric cardiac surgery.
  • Primary outcomes: reintubation rate, mortality, ICU and hospital length of stay (LOS).
  • Secondary outcomes: postoperative arterial pH, lactate, and PaCO2.

Main Methods:

  • Systematic literature search of MEDLINE, Cochrane Library, Web of Science, and Embase up to January 2025.
  • Included randomized controlled trials (RCTs) and observational studies of pediatric patients (<18 years) undergoing cardiovascular surgery.
  • Two independent reviewers performed study screening, quality assessment, and data extraction.

Main Results:

  • Twenty-nine studies (2 RCTs, 27 observational) with 9070 patients were included.
  • On-table extubation was associated with lower reintubation rates in most studies, shorter ICU and hospital LOS, and better postoperative blood gas profiles.
  • Mortality rates were comparable; however, risk of bias was elevated in observational studies.

Conclusions:

  • Selection bias is present due to the observational nature of most studies and clinician-based decisions for on-table extubation.
  • High heterogeneity across studies limits definitive conclusions and meta-analysis feasibility.
  • Well-designed RCTs are essential to confirm the benefits and safety of on-table extubation and guide patient selection.