Association between Extubation Timing and Functional Outcomes in Patients with Acute Ischemic Stroke after...

General anesthesia (GA) with endotracheal intubation is standard during endovascular treatment (EVT) for acute ischemic stroke (AIS), but the optimal timing for post-procedural extubation remains unclear.

In this retrospective cohort study, we analyzed data from 372 patients who underwent EVT under GA at our center. Extubation failure was defined as re-intubation within 48 h of extubation. Continuous variable extubation timing was categorized using thresholds of 4, 6, 8, and 24 h for analysis. Poor outcome was defined as modified Rankin scale ≥3 at discharge and 90 days.

Successful extubation was associated with favorable outcomes (p < 0.001). Among patients with successful extubation, delayed extubation beyond 24 h was associated with poor outcomes compared with extubation within 24 h (p < 0.001). The timing of extubation within the first 24 h showed distinct associations with outcomes. Extubation performed at 8-24 h was associated with poor outcomes both at 90 days (odds ratio [OR] 2.179, 95% confidence interval [CI] 1.124-4.223, p = 0.021) and at discharge (OR 2.015, 95% CI 1.065-3.811, p = 0.031) compared with extubation within 8 h. Comparisons of extubation at 4-24 h versus ≤4 h and 6-24 h versus ≤6 h showed no similar association.

Successful extubation was associated with favorable outcomes in AIS patients undergoing EVT under GA. Within the first 24 h, extubation ≤8 h was associated with better outcomes than extubation at 8-24 h. However, extubation at ≤4 h versus 4-24 h, or ≤6 h versus 6-24 h, was not associated with better outcomes.