Factors Associated with Safe Extubation in the Operating Room After On-Pump Cardiac Valve Surgery

Yiliam Rodriguez, Enisa M F Carvalho, Angela Gologorsky, Kaming Lo, Tomas Salerno, Edward Gologorsky

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Extubation in the operating room (OR) after cardiac surgery remains controversial due to safety concerns. Its feasibility had been suggested in select patients after off-pump surgery. Aim: To review the outcomes of patients extubated in the OR after on-pump cardiac valve surgery (cohort of interest) in comparison with patients extubated conventionally in the intensive care unit (ICU) (control). We hypothesized that the timing of extubation was not associated with postoperative complications. Methods: Retrospective review of 272 consecutive patients who had undergone cardiac valve surgery at Jackson Memorial Hospital, Miami, Florida between January 1, 2009 and December 30, 2013. Results: Compared with the control group, patients extubated in the OR had shorter cardiopulmonary bypass (CPB) (87 vs. 113 min, p < 0.0001) and aortic cross-clamp times (60 vs. 78 min, p < 0.0001), lower transfusion requirements (41.38% vs. 57.01%, p = 0.0342), shorter ICU (four vs. five days, p = 0.0002), and hospital stays (7.8 vs. 10 days, p = 0.0151). Mortality, overall rates of complications in all categories, ICU readmissions, and reintubations were similar in both groups. Each additional minute of CPB decreased the odds of extubation in the OR by a factor of 0.988 (odds ratio = 0.988; 95%CI: 0.980, 0.997). Pulmonary perfusion and ventilation during CPB increased the likelihood of extubation in the OR by a factor of 2.45 (odds ratio = 2.453; 95%CI: 1.247, 4.824). Conclusions: In select patients, extubation in the OR after on-pump valve surgery is safe. It is facilitated by shorter duration of CPB and pulmonary perfusion and ventilation during CPB. doi: 10.1111/jocs.12736 (J Card Surg 2016;31:274–281).

Original languageEnglish (US)
Pages (from-to)274-281
Number of pages8
JournalJournal of Cardiac Surgery
Volume31
Issue number5
DOIs
StatePublished - 2016

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Heart Valves
Operating Rooms
Thoracic Surgery
Cardiopulmonary Bypass
Intensive Care Units
Pulmonary Ventilation
Perfusion
Odds Ratio
Length of Stay
Safety
Control Groups
Mortality

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Factors Associated with Safe Extubation in the Operating Room After On-Pump Cardiac Valve Surgery. / Rodriguez, Yiliam; Carvalho, Enisa M F; Gologorsky, Angela; Lo, Kaming; Salerno, Tomas; Gologorsky, Edward.

In: Journal of Cardiac Surgery, Vol. 31, No. 5, 2016, p. 274-281.

Research output: Contribution to journalArticle

Rodriguez, Yiliam ; Carvalho, Enisa M F ; Gologorsky, Angela ; Lo, Kaming ; Salerno, Tomas ; Gologorsky, Edward. / Factors Associated with Safe Extubation in the Operating Room After On-Pump Cardiac Valve Surgery. In: Journal of Cardiac Surgery. 2016 ; Vol. 31, No. 5. pp. 274-281.
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abstract = "Background: Extubation in the operating room (OR) after cardiac surgery remains controversial due to safety concerns. Its feasibility had been suggested in select patients after off-pump surgery. Aim: To review the outcomes of patients extubated in the OR after on-pump cardiac valve surgery (cohort of interest) in comparison with patients extubated conventionally in the intensive care unit (ICU) (control). We hypothesized that the timing of extubation was not associated with postoperative complications. Methods: Retrospective review of 272 consecutive patients who had undergone cardiac valve surgery at Jackson Memorial Hospital, Miami, Florida between January 1, 2009 and December 30, 2013. Results: Compared with the control group, patients extubated in the OR had shorter cardiopulmonary bypass (CPB) (87 vs. 113 min, p < 0.0001) and aortic cross-clamp times (60 vs. 78 min, p < 0.0001), lower transfusion requirements (41.38{\%} vs. 57.01{\%}, p = 0.0342), shorter ICU (four vs. five days, p = 0.0002), and hospital stays (7.8 vs. 10 days, p = 0.0151). Mortality, overall rates of complications in all categories, ICU readmissions, and reintubations were similar in both groups. Each additional minute of CPB decreased the odds of extubation in the OR by a factor of 0.988 (odds ratio = 0.988; 95{\%}CI: 0.980, 0.997). Pulmonary perfusion and ventilation during CPB increased the likelihood of extubation in the OR by a factor of 2.45 (odds ratio = 2.453; 95{\%}CI: 1.247, 4.824). Conclusions: In select patients, extubation in the OR after on-pump valve surgery is safe. It is facilitated by shorter duration of CPB and pulmonary perfusion and ventilation during CPB. doi: 10.1111/jocs.12736 (J Card Surg 2016;31:274–281).",
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