Early extubation after congenital heart surgery

  • Mirza Halimić Paediatric Clinic University Clinical Center Sarajevo
  • Senka Mesihović Dinarević Paediatric Clinic University Clinical Center Sarajevo
  • Zijo Begić Paediatric Clinic University Clinical Center Sarajevo
  • Almira Kadić Paediatric Clinic University Clinical Center Sarajevo
  • Sanko Pandur Clinic of Cardiac Surgery University Clinical Center Sarajevo
  • Edin Omerbašić Clinic of Cardiac Surgery University Clinical Center Sarajevo
Keywords: early extubation, congenital heart disease, congenital heart surgery


Introduction: Despite recent advances in anesthesia, cardiopulmonary bypass and surgical techniques, children undergoing congenital heart surgery require postoperativemechanical ventilation. Early extubation was definedas ventilation shorter than 12 hours. Aim of this study is to identify factors associated with successful early extubation after pediatric cardiac surgery.

Methods: The study was performed during period from January 2006 to January 2011 at Pediatric Clinic and Heart Center University Clinical center Sarajevo. One hundred children up to 5 years of age, who have had congenital heart disease, with left–right shunt and obstructive heart disease were included in the study. Patients were divided into two groups: Group I - patients extubated within 12 hours after surgery and Group II - patients extubated 12 or more hours after surgery. 

Results: The most frequently encountered preoperative variables were age with odds ratio 4% 95%CI (1-7%), Down's syndrome 8.5 95%CI (1.6-43.15), failure to thrive 4.3 95%CI( 1-18). Statistically significant postoperative data included lung disease (reactive airways, pneumonia, atelectasis, pneumothorax) and with odds ratio 35.1 95 %CI (4-286) and blood transfusion with odds ratio 4.6 95%CI (2-12). Blood transfusion (p=0.002) (Wald=9.2) 95%CI (2-12), during as well as after operation procedure has statistically significant influence on prediction time of extubation. Proven markers were age with cut of 21.5 months (sensitivity 74% and specificity 70%) and extracorporeal circulation (ECC) with cut-of 45.5 minutes (sensitivity 71% and specificity 65%).

Conclusion: Early extubation is possible in many children undergoing congenital heart surgery. Younger age and prolonged ECC time are markers associated with prolonged mechanical ventilation.


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Mittnacht AJ, Hollinger I. Fasttracking in pediatric cardiac surgery - the current standing. Ann Card Anaesth. 2010;13:92-101. http://dx.doi.org/10.4103/0971-9784.62930

Heard GG, Lamberti JJJ, Park SM, et al: Early extubation after repair of congenital heart disease. Crit Care Med.1985; 13: 830-2. http://dx.doi.org/10.1097/00003246-198510000-00010

Epstein SK. Weaning from mechanical ventilation. Resp Care. 2002;47:454-66.

Harrison AM, Cox AC, Davis S, et al: Failed extubation after cardiac surgery in young children: Incidence etiology risk factors. Pediatr Crit Care Med. 2002;3: 148-52. http://dx.doi.org/10.1097/00130478-200204000-00011

Kanchi M. “Fast Tracking” Paediatric Cardiac Surgical Patients: Annals of Cardiac Anaesthesia. 2005;8:33-8.

Laussan PC, Roth SJ. Fast tracking:efficiently and safely moving patients through the intensive care unit. Progress in Pediatric Cardiology. 2003;18:149-58. http://dx.doi.org/10.1016/j.ppedcard.2003.01.015

Barash PG, Lescovich F, Katz JD, Talner NS, Stansel HC Jr. Early extubation following pediatric cardiothoracic operation: A viable alternative. Ann Thorac Surg.1980;29:228-33. http://dx.doi.org/10.1016/S0003-4975(10)61872-3

Schuller JL, Bovill JG, Nijveld A, Patrick MR, Marcelletti C. Early extubation of the trachea after open heart surgery for congenital heart disease. A review of 3 years' experience. Br J Anaesth.1984;56:1101-8. http://dx.doi.org/10.1093/bja/56.10.1101

Heard GG, Lamberti JJ Jr, Park SM, Waldman JD, Waldman J. Early extubation after surgical repair of congenital heart disease. Crit Care Med 1984;13:830-2. http://dx.doi.org/10.1097/00003246-198510000-00010

Venkataraman ST, Khan N, Brown A: Validation of predictors of extubation success and failure in mechanically ventilated infants and children. Crit Care Med. 2000;28:2991-6. http://dx.doi.org/10.1097/00003246-200008000-00051

Heinle JS, Diaz LK, Fox LS. Early extubation after cardiac operations in neonates and young infants. J Thorac Cardiovasc Surg.1997;114:413-8. http://dx.doi.org/10.1016/S0022-5223(97)70187-9

Lofland GK. The enhancement of hemodynamic performance in Fontan circulation using pain free spontaneous ventilation. Eur J Cardiothorac Surg. 2001;20:114-8. http://dx.doi.org/10.1016/S1010-7940(01)00757-6

Vida VL, Leon-Wyss J, Rojas M, Mack R, Barnoya J, Castaρeda AR. Pulmonary artery hypertension: Is it really a contraindicating factor for early extubation in children after cardiac surgery? Ann Thorac Surg. 2006;81:1460-5. http://dx.doi.org/10.1016/j.athoracsur.2005.11.050

Fischer JE, Allen P, Fanconi S. Delay of extubation in neonates and children after cardiac surgery: impact of ventilatorassociated pneumonia. Intensive Care Med. 2000;26:942–9. http://dx.doi.org/10.1007/s001340051285

Neirotti RA, Jones D, Hackbarth R, Paxson Fosse G. Early extubation in congenital heart surgery. Heart Lung Circ. 2002;11:157-61. http://dx.doi.org/10.1046/j.1444-2892.2002.00144.x

Davis S, Worley S, Mee RB, Harrison AM. Factors associated with early extubation after cardiac surgery in young children. Pediatr Crit Care Med. 2004;5:63-8. http://dx.doi.org/10.1097/01.PCC.0000102386.96434.46

Hoffman TM, Wernovsky G, Atz AM, Kulik TJ, Nelson DP, Chang AC, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation. 2003;107:996-1002. http://dx.doi.org/10.1161/01.CIR.0000051365.81920.28

Kloth RL, Baum VC. Very early extubation in children after cardiac surgery. Crit Care Med. 2002;30:787-91. http://dx.doi.org/10.1097/00003246-200204000-00011

Bandla HP, Hopkins RL, Beckerman RC, Gozal D. Pulmonary risk factors compromising postoperative recovery after surgical repair for congenital heart disease. Chest. 1999;116:740-7. http://dx.doi.org/10.1378/chest.116.3.740

Harrison AM, Cox AC, Davis S, Piedmonte M, Drummond-Webb JJ, Mee RB. Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors. Pediatr Crit Care Med. 2002;3:148-52. http://dx.doi.org/10.1097/00130478-200204000-00011

Harris KC, Holowachuk S, Pitfield S, Sanatani S, Froese N, Potts JE, Gandhi SK. Should early extubation be the goal for children after congenital cardiac surgery? J Thorac Cardiovasc Surg. 2014. http://dx.doi.org/10.1016/j.jtcvs.2014.06.093

Hamilton BC, Honjo O, Alghamdi AA, Caldarone CA, Schwartz SM, Van Arsdell GS, Holtby H. Efficacy of Evolving Early-Extubation Strategy on Early Postoperative Functional Recovery in Pediatric Open-Heart Surgery: A Matched Case-Control Study.Semin Cardiothorac Vasc Anesth. 2014 Feb 3;18(3):290-296. http://dx.doi.org/10.1177/1089253213519291

How to Cite
Halimić, M., Mesihović Dinarević, S., Begić, Z., Kadić, A., Pandur, S. and Omerbašić, E. (2014) “Early extubation after congenital heart surgery”, Journal of Health Sciences, 4(3), pp. 156-161. doi: 10.17532/jhsci.2014.165.
Research articles