Fast Track Extubation: How Effective On Patient Outcome?
Feras H. Khaliel1, Zainab M. Alayed1, Ahmed Alsulbud1, Faisal Fallatah1, Edward Devol2, Suleiman Herwis3, Adel Aly3.
1Department of Cardiac Surgery,Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 2Department of Research,Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 3Department of Anaesthesia, Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Introduction:Following cardiac surgery, early extubation is a key step in the enhanced recovery pathway as it allows for early mobilization and a quick return to regular daily activity. The aim of this study was to analyze the safety of early extubation (Ultrafast and fast track) compare to delayed extubation.Methods:A retrospective analysis of184patients. Operated via Robotic-assisted cardiac surgery in King Faisal specialist hospital, Riyadh, Saudi Arabia between February2019 - 2022. The patients were divided into Three groups according to speed of extubation, ultrafast track 41patients(in the Operating room), fast track16 patients(within six hours of ICU admission) and delayed 127 patients(more than six hours).These groups were compared interim of survival, hospital length of stay(LOS), number of blood transfusions and readmission to hospital and ICU.The mean age of the whole sample was 49,majority of patient were female(66%), body mass index minimum of 10kg/m2 and maximum 61kg/m2, one-third were diabetes, hypertension, and pulmonary hypertension,10 % decompensated heart failure, tow third were NYHA III-IV,8.2% chronic kidney disease and1.6% of them were on intermittent hemodialysis.Table -1summarized the baseline characteristics for each group separately.Results:Ultrafast extubation was practiced in our institution from the beginning of robotic program to enhance post-cardiac surgery recovery. There were four readmissions to the ICU in the delayed group and none for the other two groups(p=0.7),post-discharge readmission and mortality were not significant among the groups (p=0.9). LOS was significantly lower in the ultrafast compared to fast and delayed,(4vs 4.5vs 8 days respectively)(p= 0.0001).Blood transfusion was also significantly higher in the delayed extubation group when compare to ultrafast and fast groups,(81.9% vs 51% vs 43.7%)respectively(p = 0.0001). Only14%of the ultrafast and fast group has more than 2units of blood transfusion in comparison to58%on the delayed group(p= 0.0001).Conclusion: In Robotic cardiac surgery patients ultrafast track extubation significantly reduce hospital length of stay. There was a trend of higher mortality rate, and readmission to ICU, and hospital with delayed extubation group without statistically significance. 
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