Early extubation in adults undergoing surgery for congenital heart disease

Objectives: Early extubation in adults undergoing surgery for congenital heart disease has not been described. The authors report their experience with extubation in the operating room (OR), including factors associated with the decision to defer extubation to a later time.

Design: A retrospective chart review.

Setting: A tertiary-care teaching hospital.

Participants: This study included adults undergoing surgery for congenital heart disease using cardiopulmonary bypass. Exclusion criteria were as follows: preoperative mechanical ventilation, age >70 years, inotrope score >20 after surgery, and surgical risk (Risk Adjustment for Congenital Heart Surgery [RACHS] score ≥4).

Interventions: A stepwise logistic regression model was used to test for the independent influence of the various factors on extubation in the OR.

Measurements and main results: Sixty-seven patients (age 18-59 years, median = 32 years) were included. Overall, 79% of patients were extubated in the OR. The RACHS score was the strongest predictor of deferring extubation (RACHS 3 v 1 or 2: odds ratio = 16.7; 95% confidence interval, 3.3-84.2; p = 0.0006). Further exploration of the high-risk group (RACHS 3) showed that 75% of the RACHS 3 patients with a body mass index <25 were extubated compared with only 20% of patients who had a body mass index ≥25 (p = 0.01). Other factors included in the analysis did not contribute any additional independent information.

Conclusions: Extubation of adult patients in the OR after surgery for congenital heart disease is feasible in most cases. Surgical risk (RACHS score) and body mass index predict the decision for OR extubation in this patient population.