Ultra-fast extubation following cardiac surgery improves hemodynamic stability and reduces ICU workload

To address ICU capacity constraints, particularly during the COVID-19 pandemic, we implemented an ultrafast extubation (UFE) protocol involving operating room extubation (ORE) following on-pump cardiac surgery. We hypothesize that ORE is safe, improves postoperative outcomes, and reduces ICU workload compared with standard extubation in the ICU (ICUE).

We retrospectively analyzed 397 adult patients who underwent on-pump cardiac surgery at a tertiary center between February and October 2021. Following propensity score matching (n = 224), patients were stratified into ORE and ICUE groups. Primary outcomes included hemodynamic stability assessed via the simplified acute physiology score (SAPS) and ICU workload measured by the Therapeutic Intervention Scoring System (TISS). Secondary outcomes included duration of mechanical ventilation, vasopressor requirements, ICU and hospital length of stay (LOS), and transfusion needs.

Patients extubated in the OR demonstrated significantly lower SAPS and TISS scores on admission and cumulatively during ICU treatment (p < 0.001), reflecting improved hemodynamic stability and reduced ICU workload. ORE patients also had lower postoperative vasoactive-inotropic scores and reduced catecholamine use (all p < 0.001). ICU LOS was significantly shorter in the ORE group (median 24.5 vs. 45.0 h, p = 0.023), while hospital LOS was comparable.

Ultrafast extubation after cardiac surgery appears to be a safe and effective strategy to reduce ICU workload and resource use without compromising patient outcomes. ORE may be a valuable component of enhanced recovery protocols in cardiac surgical care.