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Quality & Patient Safety

Research Snapshot Theater: Quality and Patient Safety, Adult IV

(1297) Results of Early Extubation Protocol Based on Enhanced Recovery After Cardiac Surgery Program

Monday, February 24, 2025
9:00am – 10:00am Eastern Time
Location: Connections Central - RST 13

    First Author(s)

  • SK

    SUE HYUN KIM, MD

    Assistant professor
    Seoul National University Hospital, United States

    • Co-Author(s)

  • YL

    Yeiwon Lee, MD

    Clinical assistant professor
    Seoul National University Hospital, United States

Introduction: The objective of this study was to assess the clinical impact of standardized early extubation protocol within 6 hours after cardiac surgery based on enhanced recovery after cardiac surgery (ERAS Cardiac) program.

Methods: This study is a single-center, retrospective analysis. ERAS Cardiac program including early extubation protocol within 6 hours after surgery, multimodal opioid-sparing analgesia, and preoperative patient education has been implemented since December 2, 2019. Standardized early extubation protocol indicates evaluation of appropriate weaning criteria every 2 hours after surgery and if the patient’s condition is inappropriate for weaning until midnight, re-evaluation at 6:30 AM in the next morning. Clinical outcomes were compared between the 3 years pre- and post-ERAS Cardiac program implementation.

Results: Comparing the pre- (N = 1107) with the post- (N = 1489) ERAS Cardiac groups, median (interquartile range) duration of mechanical ventilation was decreased from 15.8 (11.2, 21.3) to 13.3 (5.8, 18.9) hours (P < 0.001). The incidence of reintubation was 5.7% (63/1107) pre-ERAS versus 4.1% (61/1489) post-ERAS implementation (P = 0.293). Total intensive care unit time was similar between two groups, a median of 47 (25, 90) and 45 (24, 87) hours consecutively (P = 0.583). Postoperative length of hospital stay was decreased from 11 (8, 18) to 10 (7, 15) days (P = 0.003). There was no significant differences in operative mortality (2.8% (31/1106) vs 2.8% (41/1489), P = 1.000) and clinically important postoperative complications between two groups, except ventilator associated pneumonia (14.0% (155/1106) vs 8.2% (122/1489), P = 0.005).

Conclusions: Pre- and Post-3 year’s clinical data after implementation of standardized early extubation protocol based on ERAS Cardiac program were associated with the significant improvements in perioperative patient outcomes. Development of further ERAS Cardiac program will leads to earlier recovery and increased safety of cardiac surgery patients.