Role of fast tract extubation in enhanced recovery after cardiac surgery: Associated factors and outcomes

Abstract

Objective: To assess the impact of fast track extubation versus late extubation in cardiac surgery patients being operated in Bahawal Victoria hospital, Bahawalpur, Pakistan. Methods: This analytical cross-sectional study was conducted in department of cardiac surgery, Bahawal Victoria Hospital, Bahawalpur, from March 2018 to March 2020. All patients who underwent cardiac surgical procedures were consecutively enrolled. Fast-track extubation (FTE) and delayed extubation (DE) in these patients were recorded. Moreover, information regarding baseline and clinical characteristics was collected and outcome like reintubations, hospital stay, and mortality were observed. Results: Of 86 patients, FTE was successful in 70 (80.14%) patients, while DE was observed in 16 (18.6%) patients. High dose inotropes 6 (37.50%) and increase drain output 5 (31.25%) were the most common cause of FTE failure among 16 patients. NYHA class was found to be significantly higher in DE group as compared to FTE group (p-value 0.002). The mean ventilation time in FTE group was significantly higher as compared to DE group, i.e., 2.7±1.6 hours vs. 6.5±4.4 hours respectively (p-value 0.001). While, inotropic support (p-value 0.047), drain volume at 4 hours (p-value 0.039), and drain at the time of removal (p-value 0.002) were significantly lower in FTE group as compared to DE group. There was a single reintubation (1.16%) and mortality (1.16%). Conclusion: FTE is a safer technique in planned cardiac surgical procedures resulting in least morbidity and mortality.