Why stop at extubation?-the difference between enhanced recovery and on table extubation after paediatric cardiac...

There remains ongoing interest in the optimal approach to the perioperative management of a subset of paediatric cardiac surgical patients characterised by lower complexity surgery, in less complex patients, the outcomes from which may be reasonably predictable. Immediate postoperative management may feature timely separation from mechanical ventilation within a specified short period after completion of surgery, together with varying approaches to the entire process of admission for surgery covering the preoperative, intraoperative and postoperative phases of care, and including time spent in an intensive care unit. The term 'fast track' became the first established descriptor of the management approach for this subset of patients. Over time, there have been further processes of evolution of the approach to perioperative management, across the range of specialties that are involved in the care of children undergoing surgical correction of a congenital heart defect. The most formalised and protocolised approach to these phases of care is, in its most modern descriptor, now more commonly referred to as 'enhanced recovery after surgery' (ERAS). This review explores the history, evolution, evidence base and current status of the approaches to managing such straightforward paediatric cardiac surgical cases and in particular the difference between ERAS compared to models of care in which primary emphasis is placed on management of intubation and subsequent extubation of the trachea, and which have been variously referred to as 'early extubation' or 'on table extubation'.