Predictors of Extubation in the Operating Room after Pediatric Cardiac Surgery: A Single Center Retrospective Study

Abstract

Abstract Objective Despite various clinical benefits of early extubation following congenital cardiac surgery, the feasibility of this strategy has been widely debated. In this study, we present the outcomes of our on-table extubation strategy in patients with congenital cardiac disease. Methods We performed a retrospective analysis of 91 patients from all age groups, operated on for congenital heart diseases. Patients were evaluated according to the STS-EACTS scoring system. Perioperative patient data were analyzed and correlated with the extubation status. Results Overall, 56% of the patients were extubated in the operating room. There was an association between younger age, longer bypass and cross-clamp times and on-table extubation. In addition, lactate as well as partial carbon dioxide pressure values in the blood gas analysis taken prior to extubation were shown to be significant with regards to extubation success. Patients with STAT expected mortality rates below 4.3% and estimated major complication rates below 6.9% were more likely to be extubated. Further, the blood gas analysis with lactate values ​​below 3.9mmol/L and partial carbon dioxide pressures below 35.3mmHg would direct the strategy in favor of on-table extubation. Moreover, there was a significant correlation between a decreased length of hospital stay and on-table extubation. Conclusion The outcomes of our on-table extubation strategy for patients with congenital cardiac disease reveal the feasibility of this approach. Higher lactate levels, younger age, increased surgical complexity are indicators of on-table extubation failure. Further, this strategy is associated with shorter ICU and hospital length of stays as an additional clinical benefit.