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Ultra-fast-track extubation is associated with reduced EEG abnormalities and improved early outcomes after pediatric
Xiaowei Li1,2, Rouyi Lin1,3, Na Du1,2
1Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangdong, China.
Insights
Ultra-fast-track extubation (UF) in pediatric cardiac surgery patients significantly reduces electroencephalogram abnormalities and seizures. This neuroprotective approach enhances early recovery, leading to shorter hospital stays and improved cerebral oxygenation.
Area of Science:
- Pediatric Cardiac Surgery
- Neurocritical Care
- Anesthesiology
Background:
- Ultra-fast-track extubation (UF) is known to improve postoperative recovery in cardiac surgery.
- However, the specific cerebral effects of UF, particularly in pediatric patients with congenital heart disease (CHD), remain incompletely understood.
- Electroencephalographic (EEG) monitoring is crucial for assessing brain function post-cardiac surgery.
Purpose of the Study:
- To compare the incidence and severity of EEG abnormalities between UF and conventional extubation (CE) in children with CHD undergoing cardiopulmonary bypass (CPB).
- To evaluate the impact of UF on early postoperative neurological recovery and clinical outcomes.
- To investigate the neuroprotective potential of UF in this vulnerable patient population.
Main Methods:
- A propensity score-matched (PSM) analysis was conducted on 352 pediatric CHD patients who underwent CPB.
- 55 UF patients were matched 1:2 with 89 CE patients, balancing key clinical characteristics.
- Intraoperative and postoperative EEGs were analyzed for background abnormalities and epileptiform discharges within the first 48 hours.
Main Results:
- The UF group exhibited significantly milder background EEG abnormalities (P=0.02) and a lower rate of unresolved abnormalities at 48 hours (7% vs. 24%, P=0.009).
- Epileptiform activity, including seizures and spikes/sharp waves, was markedly reduced in the UF group (P=0.007 and P=0.008, respectively).
- UF patients demonstrated superior cerebral oxygen saturation (ScO2), required fewer vasopressors, and had significantly shorter hospital stays (2.0 vs. 6.0 days, P<0.0001).
Conclusions:
- Ultra-fast-track extubation following pediatric cardiac surgery is associated with attenuated EEG abnormalities and reduced epileptiform activity.
- UF appears to have neuroprotective benefits, evidenced by improved cerebral oxygenation and enhanced early recovery.
- These findings support the wider adoption of UF in pediatric CHD patients to optimize neurological outcomes and clinical recovery.
Abstract:
Ultra-fast-track extubation (UF) improves postoperative recovery in cardiac surgery, but its cerebral effects remain unclear. This study compared UF and conventional extubation (CE) in children with congenital heart disease (CHD) after cardiopulmonary bypass (CPB), focusing on electroencephalographic (EEG) abnormalities during the initial 48 postoperative hours. Of 352 CHD patients undergoing CPB, 57 UF and 295 CE cases were propensity score-matched (PSM) (1:2), yielding 55 PSM-UF and 89 PSM-CE subjects. Intra/postoperative EEGs were analyzed for background abnormalities (sleep-wake cycle) and epileptiform discharges (seizures, spikes/sharp waves). Clinical parameters including STS-EACTS mortality risk and CPB duration were balanced. The PSM-UF group demonstrated milder background abnormalities (P = 0.02) and lower incidence of unresolved abnormalities at 48 h (7% vs. 24%, P = 0.009). Epileptiform activity was significantly reduced (0% vs. 11% seizures, P = 0.007; P = 0.008 for spikes/sharp waves). UF patients showed superior cerebral oxygen saturation (ScO2, P < 0.0001), reduced vasopressor requirements (P < 0.0001), and shorter hospital stays (2.0 ± 1.4 vs. 6.0 ± 5.6 days, P < 0.0001) with comparable CICU stay reductions (9.6 ± 4.1 vs. 13.3 ± 8.5 days, P = 0.002). UF following pediatric cardiac surgery correlates with attenuated EEG abnormalities and enhanced early recovery, supporting its neuroprotective benefits in CHD patients.
