FAST TRACK EXTUBATION IN ADULT PATIENTS ON PUMP OPEN HEART SURGERY AT A TERTIARY CARE HOSPITALFAST TRACK EXTUBATION IN ADULT PATIENTS ON PUMP OPEN HEART SURGERY AT A TERTIARY CARE HOSPITAL
AbstractBackground: Fast-track cardiac surgery programs have been established as the standard of cardiac surgical care. Studies have shown that early extubation in elective cardiac surgery patients, including coronary and non-coronary open-heart surgery patients does not increase perioperative morbidity and mortality. The objective of this observational study was to determine the success and failure profile of fast track extubation (FTE) practice in adult open-heart surgical patients. Methods: The study was conducted at cardiac operating room and Cardiac Intensive Care Unit (CICU) of a tertiary care hospital for a period of nine months, i.e., from Oct 2014 to June-2015. All on pump elective adult cardiac surgery patients including isolated CABG, isolated Valve replacements, combined procedures and aortic root replacements were enrolled in the study. Standardized anesthetic technique was adopted. Surgical and bypass techniques were tailored according to the procedure. Success of Fast track extubation was defined as extubation within 6 hours of arrival in CICU. Results: A total of 290 patients were recruited. The average age of the patients was 56.3±10.5 years. There were 77.6% male and 22.4% female patients. Overall success rate was 51.9% and failure rate was 48.1%. The peri-operative renal insufficiency, cross clamp time and CICU stay (hours) were significantly lower in success group. Re-intubation rate was 0.74%. Conclusion: The perioperative parameters were significantly better in success group and the safety was also demonstrated in the patients who were fast tracked successfully. To implement the practice in its full capacity and benefit, a fast track protocol needs to be devised to standardize the current practices and to disseminate the strategy among junior anaesthesiologists, perfusionists and nursing staff.Keywords: Fast Track Extubation; Adult; Open-heart surgery
Pande RU, Nader ND, Donias H, D'Ancona G, Karamanoukian HL. REVIEW: Fast-Tracking Cardiac Surgery. Heart Surg Forum 2003;6(4):244–8.
London MJ, Shroyer ALW, Jernigan V, Fullerton DA, Wilcox D, Baltz J, et al. Fast-track cardiac surgery in a Department of Veterans Affairs patient population. Ann Thorac Surg 1997;64(1):134–41.
Zhu F, Lee A, Chee YE. Fast‐track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev 2012;10:CD003587.
Toraman F, Evrenkaya S, Yuce M, Göksel O, Karabulut H, Alhan C. Fast-track recovery in noncoronary cardiac surgery patients. Heart Surg Forum 2004;8(1):E61–4.
Lassnigg A, Hiesmayr M, Bauer P, Haisjackl M. Effect of centre-, patient-and procedure-related factors on intensive care resource utilisation after cardiac surgery. Intensive Care Med 2002;28(10):1453–61.
Silbert BS, Myles PS. Is fast-track cardiac anesthesia now the global standard of care? Anesth Analg 2009;108(3):689–91.
Akhtar MI, Hamid M. Success and failure of fast track extubation in cardiac surgery patients of tertiary care hospital: one year audit. J Pak Med Assoc 2009;59(3):154–6.
Flynn M, Reddy S, Shepherd W, Holmes C, Armstrong D, Lunn C, et al. Fast-tracking revisited: routine cardiac surgical patients need minimal intensive care. Eur J Cardiothorac Surg 2004;25(1):116–22.
Constantinides VA, Tekkis PP, Fazil A, Kaur K, Leonard R, Platt M, et al. Fast-track failure after cardiac surgery: development of a prediction model. Crit Care Med 2006;34(12):2875–82.
Cheng DC, Karski J, Peniston C, Raveendran G, Asokumar B, Carroll J, et al. Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use. A prospective, randomized, controlled trial. Anesthesiology 1996;85(6):1300–10.
Scott BH, Seifert FC, Grimson R, Glass PS. Resource utilization in on-and off-pump coronary artery surgery: factors influencing postoperative length of stay—an experience of 1,746 consecutive patients undergoing fast-track cardiac anesthesia. J Cardiothorac Vasc Anesth 2005;19(1):26–31.
van Mastrigt GA, Maessen JG, Heijmans J, Severens JL, Prins MH. Does fast-track treatment lead to a decrease of intensive care unit and hospital length of stay in coronary artery bypass patients? A meta-regression of randomized clinical trials. Crit Care Med 2006;34(6):1624–34.
Ahmed N, Khan F, Zahoor M, Badar-ur-Samad, Rafique M, Faisal M, et al. Fast tracking in adult cardiac surgery at Pakistan Institute of Medical Sciences. J Ayub Med Coll Abbottabad 2010;22(3):28–31.
Ovrum E, Tangen G, Schiøtt C, Dragsund S. Rapid recovery protocol applied to 5,658 consecutive “on-pump” coronary bypass patients. Ann Thorac Surg 2000;70(6):2008–12.
Probst S, Cech C, Haentschel D, Scholz M, Ender J. A specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial. Crit Care 2014;18(4):468.