Assessment of Risk Factors for a Sustainable "On-Table Extubation" Program in Pediatric Congenital Cardiac Surgery: 5-Year Experience.
OBJECTIVE
To delineate risk factors for failure of extubation in the operating room among pediatric cardiac surgery patients.


METHODS
Prospective, observational study.


METHODS
Single center, tertiary care, teaching hospital.


METHODS
The study comprised 448 congenital cardiac surgery patients who were enrolled for intended extubation in the pediatric cardiac operating room over 5 years.


METHODS
The airways of enrolled patients were extubated in the operating room if predetermined suitability criteria were met. If the criteria were not met, patients were transferred to the intensive care unit with an endotracheal tube in situ. Patients whose airways were extubated successfully were followed up to determine specifically whether reintubation or use of noninvasive ventilation was necessary post-procedure.


RESULTS
The airways of 92% (412) patients were extubated in the operating room. Incidence of reintubation in the intensive care unit was 2.4%. There were 4 mortalities in the whole group. A 100% success rate for operating room extubation was achieved for patients in Risk Adjusted Congenital Heart Surgery category 1, and patients undergoing adult congenital cardiac disease surgery and redo sternotomy. The airways of 85% of patients with preoperative pulmonary hypertension were extubated in the operating room. Statistical analysis was applied to identify risk factors present in the group that made extubation in the operating room unachievable.


CONCLUSIONS
Extubation in the operating room was successful in a majority of patients undergoing cardiac surgery. Multivariate analysis identified weight<5 kg, age<1 year, cardiopulmonary bypass time>120 minutes, and presence of significant noncardiac structural anomalies as significant factors affecting extubation in the operating room, with an adjusted odds ratio (95% confidence interval) of 10 (2.7-37), 7.2 (2-22), 5.5 (1.7-17.7), and 3.3 (1.2-9.3), respectively. Pulmonary hypertension, redo sternotomy, higher Risk Adjusted Congenital Heart Surgery category, and aortic clamp time>60 minutes did not achieve significance in the multivariate analysis as risk factors for extubation in the operating room.
Departments of Pediatric Cardiac Sciences, New Delhi, India. Electronic address: reenakjoshi@yahoo.com.
Reena Khantwal
RK
Joshi
Departments of Pediatric Cardiac Sciences, New Delhi, India.
Neeraj
N
Aggarwal
Departments of Pediatric Cardiac Sciences, New Delhi, India.
Mridul
M
Agarwal
Research, Sir Ganga Ram Hospital, New Delhi, India.
Veronique
V
Dinand
Departments of Pediatric Cardiac Sciences, New Delhi, India.
Raja
R
Joshi
D060666:Airway Extubation / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure
fast-tracking; on-table extubation; pediatric cardiac anesthesia; pediatric cardiac surgery